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Case Study/Series
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The Use of a Biologic Tissue Matrix (Integraª Bilayer Matrix Wound Dressing) in First Author: Steven Rottman Authors: Steven J. Rottman, MD, Paul M. Glat, MD Pseudosyndactyly, a mitten deformity of the hand, is a serious problem that can arise in children with recessive dystrophic epidermolysis bullosa (EB). The authors present 2 cases of patients who developed significant contractures of their hands with limited functional use secondary to pseudosyndactyly. At the time of both initial operations, digit separation and contracture releases were performed, which resulted in large areas of denuded skin on the palmar and volar aspect of the fingers and hand. A biologic tissue matrix (Integraª Bilayer Matrix Wound Dressing, Integra Lifesciences Corp., Plainsboro, NJ) was used initially to cover the wounds. Subsequently, a bioengineered skin equivalent(Apligrafª,Organogenesis Inc., Canton, Mass) was used for epidermal coverage. The biologic tissue matrix was selected because of its excellent tensile strength, flexible adherent covering, and success with decreasing the incidence of postoperative wound contracture, which the authors believed was necessary for the hands to heal successfully. Skin grafting was not an option in either case because the patients did not have any suitable harvest sites secondary to the generalized blistering as a result of the epidermolysis bullosa. The bioengineered skin equivalent was used to promote reepithelization of the neodermis created by the biologic tissue matrix by delivering multiple growth factors and cytokines. |
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