SCIENTIFIC ARTICLE Use of Integra Artificial Dermis to Reduce Donor Site Morbidity After Pedicle Flaps in Hand Surgery Roberto Adani, MD, Leonardo Rossati, MD, Luigi Tarallo, MD, Massimo Corain, MD Purpose To assess the results obtained with Integra artificial dermis to cover donor site following the harvesting of pedicle flaps for hand reconstruction. Methods Between April 2010 and August 2013, 11 patients (8 men and 3 women; mean age, 37 y) were treated with Integra Dermal Regeneration Template (Integra LifeSciences, Inc., Plainsboro, NY) to cover donor defects after raising pedicle flaps for hand and finger recon- struction: radial forearm flap (4 cases), ulnar artery perforator flap (2 cases), and heterodigital island flap (5 cases). After neodermis formation the silicone layer of the artificial dermis was removed (on average after 22 days) and a split- or full-thickness epidermal autograft placed. Results No infections, hematoma, or bleeding were recorded during the entire phase in which the artificial skin was applied. Two patients experienced a partial skin graft loss. Median follow-up was 20 months, and results included an average Vancouver Scar Scale rating of 2.7 and an average DASH score of 39. There were no cases of graft adherence to the underlying tendons or muscles. Conclusions Favorable cosmetic and functional outcomes were obtained using a dermal regeneration template for the treatment of donor site defects. Despite the drawback of an additional surgical procedure (secondary skin graft), the use of this artificial skin produced soft-tissue augmentation and graft-skin quality, reducing donor site morbidity. (J Hand Surg Am. 2014;39(11):2228e2234. Copyright Ó 2014 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Therapeutic IV. Key words Dermal substitute, donor site morbidity, Integra, pedicle flaps, radial forearm flap. I NTEGRA (INTEGRA DERMAL REGENERATION Template; Integra LifeSciences, Plainsboro, NJ) is an acel- lular bilaminate dermal-substitute membrane that was initially used for the treatment of life-threatening third-degree burns. 1 The template consists of an inner layer of collagen and chondritin-6-sulfate covered by a temporary silicone epidermal substitute (generally removed after 3 weeks), the deeper layer allows the migration of fibroblasts, macrophages, lymphocytes and capillary ingrowth onto the surface to regenerate the dermis. 2,3 This artificial skin comes in different sizes and forms, either with a silicone membrane (bilayered) or without the silicone sheet. In this latter form it can be directly covered with a skin graft. Integra allows for neodermis to form over the surface of the wound and minimizes the number of migrating myofibrolasts. This results in less contraction with fewer adhesions to the underlying joints, tendons, and nerves. 4 Integra has been successfully used in the treatment of burned hands, 4 after tumor resection, 5e7 in degloving injuries, 8,9 for severe traumatic wounds of the hand and digits, 2,10e12 and in the treatment of From the Department of Hand Surgery and Microsurgery, University Hospital of Verona, Verona; and the Department of Orthopedic Surgery, University of Modena and Reggio Emilia, Modena, Italy. Received for publication April 2, 2014; accepted in revised form August 12, 2014. No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. Corresponding author: Roberto Adani, MD, Department of Hand Surgery and Micro- surgery, University Hospital Verona, Ospedale GB Rossi, Piazzale LA Scuro 10, Verona, Italy; e-mail: roberto.adani@ospedaleuniverona.it. 0363-5023/14/3911-0014$36.00/0 http://dx.doi.org/10.1016/j.jhsa.2014.08.014 2228 r Ó 2014 ASSH r Published by Elsevier, Inc. All rights reserved.