Complex wound management with an artificial dermal regeneration template

The following case reports on the successful use of Integra® (Integra LifeSciences, Plainsboro, NJ) as an alternative for coverage of exposed tibia in a patient with necrotizing fasciitis and significant comorbidities. Necrotizing fasciitis is a generalized term that is used to describe soft tissue infections in which necrosis of the fascia and subcutaneous tissue occurs. Necrotizing fasciitis will often begin with disproportionate pain, localized erythema, and skin discoloration with vesicle formation. As the disease progresses along fascial planes, an area of deep necrosis develops with eventual signs of systemic toxicity and sepsis. Diagnosis of this condition can be quite challenging, and the diagnostic value of laboratory tests is limited. Aggressive treatment of necrotizing fasciitis is extremely important; the infection develops rapidly and can quickly lead to systemic toxicity and death. Traditionally, management of necrotizing fasciitis consists of resuscitation and stabilization of the patient, aggressive surgical debridement of all nonviable tissue, and the administration of broad-spectrum antibiotics. Reconstructive surgery is indicated for many patients who have recovered from necrotizing fasciitis. Integra, an artificial dermal regeneration template (DRT), has emerged as an adjunct to split-thickness grafts or tissue transfers. This case exemplifies the potential for DRT to provide another, more direct alternative for coverage of a complex, exposed wound. .