Purpose: Dorsal hand defects occur commonly. A variety of options exist for reconstruction but donor site morbidity and need for a thin graft that allows tendon sliding are limiting factors. Coverage of tendons with Integra has been performed in the burn setting and we sought to apply this to traumatic dorsal hand defects.

Methods:

Two patients with dorsal hand defects were reconstructed using integra. Wounds were debrided and tendon reconstructions were done in the acute trauma setting. Negative pressure therapy was applied and serial debridements and wound VAC changes were done as necessary. Integra was placed as a single or double layer and split thickness skin grafts were placed over the Integra.

Results:

Integra healing over granulating wounds with exposed tendons was excellent. Split thickness skin graft take over Integra grafts were complete in both patients. All tendons were covered and movement of tendons in hand therapy was acceptable. Reconstructed defects had superior contour over other options and acceptable color match to surrounding skin.

Conclusions:

Integra reconstruction of dorsal hand injuries with exposed tendons is shows promise as a highly effective method. With further refinements this technique could become standard practice for a large subset of dorsal hand wounds.