Conclusion
Even with optimal treatment, complex finger injuries present a great challenge for surgeons and hand therapists, and ultimately affect patients' quality of life. In the acute setting, tendons, nerves, and bones, if left open, will desiccate, devitalize, and eventually scar, with resulting deformity and poor function. For these reasons, a rapid way to reconstruct soft tissue and provide adequate coverage is paramount in order to achieve good functionality and cosmesis.
Artificial dermal substitutes, such as Integra, offer a viable alternative for complex wound treatment when primary closure is unachievable. In the present series, 69.2% of the patients were treated with ADS alone without any need for subsequent grafting. When further grafts were required, they were much smaller than what they would have been with native flaps, which translates to less pain (ie, smaller wounds), and lack of additional donor site wounds further improving patient satisfaction, and possibly decreased costs from fewer repeat operations. Additionally, less need for CFFs allows patients without fractures the benefit of earlier mobilization, thus minimizing joint stiffness and hospitalization. Artificial dermal substitute application also allows CHTs to better address concurrent repairs (eg, patients with tendon and pulley repairs can start hand therapy immediately after ADS application), compared to the longer immobilization needed with the use of CFFs (Figure 1).
The authors acknowledge that this particular study is limited due to selection bias, its retrospective nature, and lack of an appropriate control. Even though it has low statistical value, it demonstrates potential benefits from the use of ADS. Larger prospective studies are needed to address the cost effectiveness of using ADS for complex reconstructions compared to traditional methods, as well as studies to evaluate patients' pain ratings and satisfaction by use of a formal scale, such as Disabilities of the Arm, Shoulder, and Hand (DASH) or the Patient-Rated Wrist/Hand Evaluation (PRWHE).