Artificial Dermal Matrix Research Articles

Hand and wrist complete degloving: A case report and litterature review

Complete hand degloving injuries are traumatic avulsion injuries causing the skin to pull away from the underlying tissues and are most often caused by industrial machinery. We present the case of a degloving trauma of the whole fingers, hand, and wrist resulting in a "watch hand" by analogy with the "ring finger" and discuss alternatives and recommendations from the rare cases described of similar traumas. A 33-year-old manual worker, a non-smoker with no significant medical or surgical comorbidities, was admitted for a complete skin avulsion of the left hand and wrist following a work-related accident with a trommel-type industrial roller. Our approach covered the five fingers and the dorsal aspect of the hand and wrist with an artificial dermal matrix, while the palmar side of the hand and wrist was covered with a pedicled groin flap in emergency. At 15months, the patient's sensitivity was classified as S1 on the sensory evaluation scale, joint mobility was less than 30°, and the residual hand retained what we might call "basic" functions, i.e., a counterweight when carrying loads and the ability to pick up and hold a light object in the thumb-index grasp. Complete soft tissue hand defects are exceptional and require urgent treatment. If re-implantation is not possible, combining a dermal matrix with a pedicled flap is a simple salvage solution. The risks of vascular, infectious, and stiffening complications in these traumas are high and must be prevented. Patients must be warned of the severity of the trauma, the need for secondary surgeries to restore a policy-digital grip, and the poor functional results expected.

Managing Vascular Pedicle Exposure in Free Tissue Transfer Using a Reprocessed Micronized Dermal Substitute in Lower Extremity Reconstructions.

Lower extremity reconstruction is challenging because of its intricate anatomy and dynamic biomechanics. Although microsurgical free tissue transfer offers pivotal solutions to limited local tissue availability, vascular pedicle exposure after free tissue transfer is common. We evaluated a novel method of managing pedicle exposure after free tissue transfer using a reprocessed micronized dermal substitute. Ten patients who underwent lower-extremity reconstruction using free tissue transfer and micronized dermal substitute between January and December 2023 were retrospectively reviewed. When native tissue could not be closed over the pedicle, reprocessed micronized artificial dermal matrix (rmADM) was cut and stacked to protect and stabilize it. Epithelialization was achieved by secondary skin grafting or healing by secondary intention. Flap dimensions, recipient artery and vein, ADM size, time required for granulation tissue maturation and complete epithelialization, and flap outcomes were analyzed. The mean age was 55.80 ± 20.70 years, and six patients (60%) were diabetic. The mean rmADM coverage area was 8.70 ± 8.41 cm2, and the average time required for complete epithelialization was 50.89 ± 14.21 days. Except for one total necrosis due to bypass graft failure, nine limbs were successfully salvaged. Application of rmADM offers numerous advantages, including vascular collapse prevention, moisture maintenance, granulation tissue growth promotion, and pedicle stabilization.

How to Reduce Inferomedial Orbital Wall Fracture Using a Navigation System: Tips and Pearls.

The orbit is a confined space with a defined bony structure. Bony protrusion into the ethmoid or maxillary sinuses by the blowout fracture can displace orbital tissues, including rectus muscles and adjacent fascial septae. Especially, reconstructing the orbit's floor and medial wall can be challenging when the inferomedial strut or posterior bony ledge is affected, leading to a loss of critical anatomic landmarks and support. Correctly positioning an implant in the precise anatomic location can be challenging. Recent updates to the navigation system have addressed this issue. Despite its early application, using a navigation system in these orbital fractures advances plastic surgeons in a way that has more confidence and accuracy in surgical planning. The video demonstrates how these 2 can be combined in an operating room. Intraoperatively, the authors check the superior, anterior, and posterior ends of the medial wall fracture and the posterior end of the floor fracture. A single orbital implant was trimmed and reshaped to match defect measurements. The implant placement was meticulously executed to repair the fracture while ensuring the inferior oblique muscle was not injured. After confirming the correct placement of the implant, it was secured to the inferior orbital rim using a single screw. Depending on the medial orbital wall fracture depth or degree of soft tissue herniation, the authors used an artificial dermal matrix or trimmed absorbable mesh plate to cover the uppermost part of the medial wall fracture to prevent postoperative enophthalmos. Finally, a forced duction test was performed. Our study shows that navigation-assisted inferomedial orbital wall reconstruction using materials readily available in the market is safe and effective.

Characteristics of multilineage-differentiating stress-enduring cell clusters in different culture conditions.

To observe the morphological characteristics of clusters of Muse cells from normal human dermal fibroblasts (NHDFs) under different culture conditions. Muse cells were sorted by magnetic activated cell sorting (MACS) from NHDFs, and were evaluated by flow cytometry. Muse cells were cultured in suspension and in adherent conditions to obtain Muse cell clusters (M-clusters), which were further characterized by alkaline phosphatase (AP) staining, immunofluorescence (IF) staining and transmission electron microscopy (TEM). The M-clusters were further cultured on Lando artificial dermal regeneration matrix (LADRM) for analysis by scanning electron microscopy (SEM) and IF staining of frozen sections. The proportion of SSEA3 and CD105 double-positive cells obtained by MACS was 87.4%. The sorted cells rapidly formed M-clusters after suspension culture, and showed internal characteristics of stem cells under TEM. After adherent culture, M-clusters stained positively for AP, SSEA-3 and OCT-4. Each M-cluster on the surface of the LADRM displayed an outer membrane of amorphous materials under SEM. Frozen sections and fluorescence staining of LADRM loaded with M-clusters showed an uneven fluorescence intensity of SSEA-3 within the clusters. Muse cells sorted by MACS from NHDFs could generate M-clusters, which included cells of different stemness and are wrapped in membrane-like structures.

Single-stage acellular dermal matrix reconstruction of defects in the nose and ears with exposed cartilage: a prospective case series

BackgroundThe treatment of soft tissue defects with exposed cartilage after tumor excision is challenging. Local flap reconstruction causes occasional scarring, especially in non-Caucasian populations. Scar treatment requires secondary procedures for aesthetic modifications. Two-step reconstruction with an acellular dermal matrix addresses this issue and yields highly acceptable aesthetic resultsWe aimed to investigate the efficacy of an artificial dermal matrix cover using one-step reconstruction for defects with cartilage exposure.MethodsFrom July 2018 to September 2020, seven patients were enrolled and underwent a single-stage operation using acellular dermal matrices. Patients were followed up for at least 6 months and the size of the wound, days to heal, patient satisfaction, and scar scale scores were recorded.ResultsPatients were followed up for an average of 25.7 months. The average time to heal was 23.4 days postoperatively. No hyperpigmentation, tumor recurrence, or retraction was noted. High acceptance and satisfaction with the outcome were observed in all patients.ConclusionsSingle-stage reconstruction yielded high acceptance of aesthetic results similar to that in two-stage reconstruction. Less time and cost make this an effective and efficient treatment for soft tissue defects compared with traditional techniques.

Reconstruction of a high-energy penetrating injury from the abdomen to the sacral area using a latissimus dorsi free flap with monofilament polypropylene mesh and pedicled flap rotation: a case report

A 50-year-old man was transferred to a level I trauma center for penetrating injury. Industrial metal had penetrated his trunk, and he was injured in internal organs. The injured internal organs were treated by the trauma surgery team. The peritoneum was reconstructed with artificial dermal matrix graft. The wound was managed with negative-pressure wound therapy, and several debridement procedures were performed. The full-thickness abdominal defect was covered with monofilament polypropylene mesh(Parietene mesh, 30×30 cm). A latissimus dorsi flap was elevated with a musculocutaneous flap measured 50×30 cm, and 6-cm thoracodorsal artery pedicle. Microvascular anastomosis was performed using the thoracodorsal and left femoral arteries. Two weeks later, we performed local flap rotation based on gluteal artery perforator in the sacral area. Polypropylene mesh was successfully inserted without complications. Combining a latissimus dorsi free flap on a polypropylene mesh can be an effective method for reconstructing large penetrating wounds on the trunk.

709 Two-Layer Biodegradable Temporizing Matrix Reconstruction of Abdominal Wall Dermatofibrosarcoma Protuberans

Abstract Dermatofibrosarcoma protuberans (DFSP) is a rare, locally invasive dermal sarcoma. The management is generally surgical, with wide local excision (WLE) forming the mainstay of treatment. Large abdominal wall defects are most aesthetically reconstructed using pedicled or free flaps; however, these require tumour-free surgical margins, and can cause donor site morbidity. We describe an alternative, aesthetic, and low-morbidity technique for abdominal wall reconstruction following WLE of DFSP, using 2 layers of a novel synthetic dermal matrix (NovoSorb® BTM). 25-year-old women presented with a large DFSP involving the right anterior-abdominal wall. After WLE with 3cm margins, BTM was implanted to the large sub-fascial abdominal wall defect. At 6 weeks, after histological confirmation of tumour-free margins, a second layer of BTM was applied to improve the significant contour deformity of the wound bed. After complete integration by 7 weeks, a split-thickness skin graft was harvested from the right thigh and fixed to the new dermis. At 14-days postoperatively, the skin graft had fully taken, and donor site healed. By 8 weeks, the scar had started to mature with no obvious contour defect or contracture. Overall, the patient was satisfied with the functional and aesthetic outcome. To our knowledge, a two-layer reconstruction using an artificial dermal matrix has never been described for abdominal wall reconstruction. We found that double-layer BTM is able to restore the inherent thickness and pliability of skin in complex abdominal wall reconstruction following WLE of DFSP and offers improved durability and cosmesis compared to skin grafting or indeed single layer skin substitutes alone.

EP-175 Two-layer Biodegradable Temporizing Matrix Reconstruction of Abdominal Wall Dermatofibrosarcoma Protuberans

Abstract Dermatofibrosarcoma protuberans (DFSP) is a rare, locally invasive dermal sarcoma. The management is generally surgical, with wide local excision (WLE) forming the mainstay of treatment. Large abdominal wall defects are most aesthetically reconstructed using pedicled or free flaps; however, these require tumour-free surgical margins, and can cause donor site morbidity. We describe an alternative, aesthetic, and low-morbidity technique for abdominal wall reconstruction following WLE of DFSP, using 2 layers of a novel synthetic dermal matrix (NovoSorb® BTM). A 25-year-old women presented with a large DFSP involving the right anterior-abdominal wall. After WLE with 3cm margins, BTM was implanted to the large sub-fascial abdominal wall defect. At 6 weeks, after histological confirmation of tumour-free margins, a second layer of BTM was applied to improve the significant contour deformity of the wound bed. After complete integration by 7 weeks, a split-thickness skin graft was harvested from the right thigh and fixed to the new dermis. At 14-days postoperatively, the skin graft had fully taken, and donor site healed. By 8 weeks, the scar had started to mature with no obvious contour defect or contracture. Overall, the patient was satisfied with the functional and aesthetic outcome. To our knowledge, a two-layer reconstruction using an artificial dermal matrix has never been described for abdominal wall reconstruction. We found that double-layer BTM is able to restore the inherent thickness and pliability of skin in complex abdominal wall reconstruction following WLE of DFSP and offers improved durability and cosmesis compared to skin grafting or indeed single layer skin substitutes alone.

Application of Lando® Artificial Dermal Regeneration Matrix in Treatment of Challenging Scar Contracture Release of a Severely Deformed Wrist: A Case Report

Application of Lando® Artificial Dermal Regeneration Matrix in Treatment of Challenging Scar Contracture Release of a Severely Deformed Wrist: A Case Report

A novel technique to prevent the breast implant from exposure after mastectomies

Introduction After mastectomies, we do our reconstruction, either immediately or delayed. In both ways of reconstruction for post mastectomies defect, the most commonly performed reconstruction is by using breast prosthesis [1]. For many years, surgeons have been trying to find out any solution to reduce the rate of implant exposure and develop some new techniques and modifications. However, once the infection develops or implant expose the only permanent solution is to remove the implant [2-3]. Although there is less evidence found in the literature regarding the salvage of implant once the infection occurs and when implant becomes expose in implant-based reconstruction [4]. Radiation also plays additional role in post-operative complication rates following implant-based breast reconstruction, as it is well documented that the incidence of complications is to be higher in radiated breasts compare to similar non-radiated breasts [5]. With the new advancement in radiation therapy the number of patients have been increasing who are receiving radiation therapy after immediate breast reconstruction [5]. Description of the Technique For more than 15 years we have been reconstructing the breasts deformities after different types of mastectomies, ranging from skin sparing, nipple areola sparing to different types of lumpectomies, by immediate insertion of breast implants. The main problem which we face during post-reconstruction, is the exposure of implant in addition to infection. With the advent of ADM (Artificial Dermal Matrix) [6], serratus anterior muscle [7], rectus fascial flap [7] and inferior dermal flaps [8] although they do an addition to thickness of skin envelop over the implant after mastectomy, but still the rate of implant exposure has not changed noticeably. It has been well understood that of ADM expose in air it dries immediately which later on results in implant exposure. Meanwhile we have developed a novel tech- nique to augment the soft tissue coverage under the incision line over the ADM and implant. By this way, if there is any dehiscence over suture line, there will be no implant exposure as there is additional soft tissue layer of dermal flap. These dermal flaps are actually a de-epithelialized dermal flap from the inferior half of the breast skin, which we used to excise and throw it to the garbage, particularly in skin sparing mastectomies. In this technique we suture the inferior based dermal flap over the artificial dermal matrix in a way that suture lines of skin flaps of mastectomy lie over the de-epithelialized dermal flap, which actually in- crease the survivability of ADM as well as increase the thickness of soft tissue over the implant (figure 1 and 2). By addition of this layer of de-epithelialized dermal flaps over the artificial dermal matrix and breast implants have promising reduction effect over implant exposure as well as it provides the additional vascularized soft tissue layer over the implant. Although we are using dermal flap with ADM frequently in most of our skin spring mastectomies but we did this new technique in 2 patients till now with the mean follow up of 8 weeks till now there is not a single case report of implant exposure in those patients (figure 3).

Long V-Y advancement technique for large nipple reconstruction in Asian women.

Previously reported nipple-areolar complex reconstruction (NAR) methods involve multiple incisions and wide skin redraping, which increase retraction forces and heighten the risk of nipple-areolar complex (NAC) flattening. We introduce a NAR method using the long V-Y advancement technique that can overcome these disadvantages. A V-shaped flap is designed with the width of the flap base 4–5 mm larger than the diameter of the normal nipple. The flap length is designed to be at least 2.5 times its width. Dissection is performed to the top of the artificial dermal matrix or muscle layer. The nipple is constructed with the same projection as the contralateral side by folding the elevated flap. The tip of the elevated flap is apposed in the middle of the donor defect to minimize the deformity during donor site closure. A 3-point skin suture is applied to the upper third of the folded flap to mold its shape. Using this long V-Y advancement technique, we successfully decreased skin tension in NAC flaps and improved the maintenance of reconstructed nipple projection. The long V-Y advancement technique provides an easy, simple NAR method, effectively maintaining longer nipple projections and reducing breast deformities, especially in Asian women with relatively large nipples.

Successful Reconstruction of Bone and Soft Tissue Defect Using Artificial Dermal Matrix after Hand Injury due to Dog Bite

Here we report a successful treatment of animal bite wound involving the bone. We used an artificial dermal matrix to reconstruct the cortical defect and prevent adhesion of the tendinous structures. A 48-year-old woman visited the emergency department for a painful hand swelling due to a dog bite 2 months earlier. A physical examination revealed a firmly palpable lesion with swelling and tenderness on the dorsal aspect of her hand. Magnetic resonance imaging found lytic changes of the second metacarpal bone with cortical destruction and fluid collection. After debridement of the necrotic tissue, a cortical bone defect with inflammatory changes of the medulla was noted. Following several days of irrigation, an artificial dermal matrix was applied with skin flap coverage to restore the soft tissue and bone defect. Three months later, the patient showed good motion of her hand without any restrictions. We believe artificial dermal matrix can be a good treatment strategy for restoring bone defect and preventing tendon adhesion simultaneously.

Biocompatibility and Immunotoxicology of the Preclinical Implantation of a Collagen-based Artificial Dermal Regeneration Matrix

ObjectiveGraft rejection, with the possibility of a violent immune response, may be severe and life threatening. Our aim was to thoroughly investigate the biocompatibility and immunotoxicology of collagen-based dermal matrix (DM) before assessment in clinical trials. MethodsDM was subcutaneously implanted in BALB/c mice in two doses to induce a potential immune response. The spleen and lymph nodes were assessed for shape, cell number, cell phenotype via flow cytometry, cell activation via CCK8 kit, Annexin V kit, and Ki67 immunostaining. Serum samples were used to measure antibody concentration by enzyme-linked immunosorbent assay. Local inflammation was analyzed by histology and immunohistochemistry staining. Data analysis was performed by one-way ANOVA and non-parametric tests. ResultsOur data illustrate that the spleen and lymph node sizes were similar between the negative control mice and mice implanted with DM. However, in the high-dose DM (DM-H) group, the total cell populations in the spleen and lymph nodes, T cells and B cells in the spleen had slight increases in prophase, and the low-dose DM (DM-L) group did not display gross abnormities. Moreover, DM-H initiated moderate cell activation and proliferation in the early phase post-immunization, whereas DM-L did not. Neither DM-H nor DM-L implantation noticeably increased IgM and IgG serum concentrations. Examination of the local cellular response revealed only benign cell infiltration and TNF-α expression in slides of DM in the early phase. ConclusionOverall, DM-H may have induced a benign temporary acute immune response post-implantation, whereas DM-L had quite low immunogenicity. Thus, this DM can be regarded as a safe product.

Artificial Acellular Dermal Matrix Presenting as a Nodule in Thyroidectomy Patient

Artificial Acellular Dermal Matrix Presenting as a Nodule in Thyroidectomy Patient

Matriderm for Management of Scalp Necrosis Following Surgical Treatment of Giant Parietal Encephalocele.

Management of encephaloceles is challenging when massive brain herniation is present. In such instances, an expansile cranioplasty may be attempted so as to preserve some herniated brain tissue. Complications such as wound dehiscence, cerebrospinal fluid leak, and scalp necrosis are postoperative concerns. The treatment of scalp necrosis with dural and brain exposure is certainly a challenge due to the complexity of flap techniques in such a young age. Herein we describe the use of a novel technique for the management of a scalp necrosis and dehiscence in an infant. A patient with a giant parietal encephalocele and massive brain herniation underwent an expansile cranioplasty. A large scalp necrosis ensued as a complication and later progressed to a suture dehiscence despite a new surgical intervention, with resultant brain exposure. A scalp reconstruction was subsequently performed using an artificial dermal substitute, laid directly onto the brain, followed by a split-thickness skin graft. We observed a rapid engraftment, without any further complications, with an acceptable cosmetic result in the long-term follow-up. A simple technique, such as the use of an artificial dermal matrix with simultaneous split-thickness skin graft, may be an effective treatment for the repair of scalp defects, even when coverage of exposed brain tissue is necessary, when no other techniques are found to be suitable.

Abstract: The Role of Acellular Dermal Matrix in Prevention of the Postoperative Adhesion after Tenorrhaphy in the Hand

INTRODUCTION: Tendon rupture is one of the most frequently occurring trauma in the hand. Because postoperative adhesion around the area of tenorraphy is almost inevitable, there have been numerous intraoperative and postoperative methods suggested by the surgeon around the world, including tenorrhaphy methods, suture material itself, anti-adhesion agents or postoperative physical therapy. Among the anti-adhesion agents, artificial dermal matrices were not proven in their efficacies in the prevention of adhesion yet.1–3 We present the long-term follow-up data and their role in tenorrhaphy. METHODS: The study was performed in single institution, Uijeongbu St. Mary’s Hospital, one of the national emergency headquarter in South Korea. A total of 87 patients was enrolled in the study. Single tendon rupture cases in Flexor zone I from index finger to little finger were included in the study, and the previous trauma history or underlying disease affecting the motion of the hand were considered as exclusion criteria. The tenorrhaphy was performed by single surgeon, HS Shim, and the bovine dermal matrix was wrapped around the tenorrhaphy site before the skin closure in the study group. The hyaluronic acid based anti-adhesion agents was applied in both group. RESULTS: The results were assessed by the postoperative range of motion (ROM). The range of the motion in the distal / proximal interphalangeal joint (DIPJ / PIPJ) was recorded at 6-month postoperative period. In the control group of 46 patients, the average ROM was 78 / 75 degrees respectively. In the study group of 41 patients, the average ROM was 84 / 85 degrees which was significantly greater than control group. CONCLUSION: The surgeon should be aware of multiple strategies for prevention of adhesion in tenorrhaphy of the hand. Among these, the artificial dermal matrix has a definite role for anti-adhesion by creating barrier from adjacent tissue. Reference Citations: 1. Iorio ML, Shuck J, Attinger CE. Wound healing in the upper and lower extremities: a systematic review on the use of acellular dermal matrices. Plast Reconstr Surg 2012;130(5 Suppl 2):232S-41S. 2. Haslik W, Kamolz LP, Manna F, Hladik M, Rath T, Frey M. Management of full-thickness skin defects in the hand and wrist region: first long-term experiences with the dermal matrix Matriderm. J Plast Reconstr Aesthet Surg 2010;63(2):360–4. 3. Wetzig T, Gebhardt C, Simon JC. New indications for artificial collagen-elastin matrices: Covering exposed tendons. Dermatology 2009;219(3):272–3.

How achievable are ABS/BAPRAS guidelines for artificial dermal matrix assisted breast reconstruction?

How achievable are ABS/BAPRAS guidelines for artificial dermal matrix assisted breast reconstruction?

Commentary on: Histologic, Molecular, and Clinical Evaluation of Explanted Breast Prostheses, Capsules, and Acellular Dermal Matrices for Bacteria.

“Extraordinary claims require extraordinary evidence”Carl Sagan1 The authors of this study have examined capsule, tissue expander (TE), and artificial dermal matrix (ADM) specimens obtained from 26 patients randomly selected from a group 147 women undergoing exchange procedures for definitive breast implants using a variety of histological, imaging, and molecular techniques to detect bacteria.2 Of these 26 patients, two patients demonstrated bacteria on a culture and scanning electron microscopy, respectively. The authors conclude based on these findings that “biofilms likely contribute to a proportion but not all diagnosed capsular contractures” (CC). In 1978, Costerton described his biofilm theory, postulating that bacteria adhere to available surfaces in glycocalyx-enclosed sessile masses and that this structure is the predominant state in natural, industrial, and, particularly, medical ecosystems.3 By doing so, he alerted the world to a new menace and forced a paradigm shift in the way we view infection. Prior to this, many chronic implant-associated inflammation was deemed “sterile” based on the inability to culture microorganisms using traditional microbiological techniques. The advent of sensitive detection and imaging techniques, however, has now established biofilm as the central cause of an increasing number of device-associated infections (DAI).4 Biofilm-related DAI has been reported in joint prostheses, penile prostheses, fracture fixation devices, intravenous and urinary catheters, peritoneal dialysis catheters, contact lenses, endoscopes, cardiovascular and biliary stents, neurosurgical prostheses, cochlear implants, and, pertinent to this study, breast implants.4 The difficulty with detecting biofilm in the clinical and research setting, however, cannot be underestimated. As the number of bacteria within a biofilm community only account for 15% of the total mass, the low numbers can be difficult to isolate.5 Additionally, the firm adherence of the protective glycoprotein matrix needs to be disrupted prior to release of these bacteria into culture medium for subsequent …

MSCs seeded on bioengineered scaffolds improve skin wound healing in rats.

Growing evidence has shown the promise of mesenchymal stromal cells (MSCs) for the treatment of cutaneous wound healing. We have previously demonstrated that MSCs seeded on an artificial dermal matrix, Integra (Integra Lifesciences Corp., Plainsboro, NJ) enriched with platelet-rich plasma (Ematrix) have enhanced proliferative potential in vitro as compared with those cultured on the scaffold alone. In this study, we extended the experimentation by evaluating the efficacy of the MSCs seeded scaffolds in the healing of skin wounds in an animal model in vivo. It was found that the presence of MSCs within the scaffolds greatly ameliorated the quality of regenerated skin, reduced collagen deposition, enhanced reepithelization, increased neo-angiogenesis, and promoted a greater return of hair follicles and sebaceous glands. The mechanisms involved in these beneficial effects were likely related to the ability of MSCs to release paracrine factors modulating the wound healing response. MSC-seeded scaffolds, in fact, up-regulated matrix metalloproteinase 9 expression in the extracellular matrix and enhanced the recruitment of endogenous progenitors during tissue repair. In conclusion, the results of this study provide evidence that the treatment with MSC-seeded scaffolds of cutaneous wounds contributes to the recreation of a suitable microenvironment for promoting tissue repair/regeneration at the implantation sites.

Treatment of the Radial Forearm Flap Donor Site with Single-Stage Integra™ Artificial Dermal Matrix and Autograft

INTRODUCTION: Optimal treatment of the radial forearm flap donor site remains a difficult clinical problem, with complications including unsightly scarring, tendon exposure, and impaired range of motion and strength. Integra™ artificial dermal matrix has been described as an alternative to autograft alone for the reconstruction of these donor site defects using a two-stage process.1,2 This study is a retrospective review of a consecutive series of radial forearm flap donor sites that have been treated with monolayer Integra™ artificial dermal matrix and autograft in a single stage. METHODS: Fourteen consecutive cases of radial forearm free flaps performed between June 2011 and June 2013 were reviewed. In each case, the donor site was reconstructed using monolayer Integra™ artificial dermal matrix and autograft in a single stage. After routine harvest of the flap, monolayer Integra artificial dermal matrix was meshed and applied to the wound. A split-thickness skin graft was then harvested and either meshed or pie-crusted prior to application over the Integra™. A negative pressure wound dressing was applied over the grafts for 5-7 days. The donor site was evaluated with regards to skin graft take, scar appearance, strength and range of motion, paresthesias, infection, and the need for secondary interventions. RESULTS: The fourteen patients had a mean age of 53 years old (range 20-68) and radial forearm donor site defect area of 65 cm2 (range 30-110 cm2). Follow up time ranged from four to 18 months. All defects had >98% skin graft take. There were no infections, and no patients required secondary intervention. Hypertrophic scarring was not seen in any patient, although 2/14 patients had some degree of scar hypopigmentation. 2/14 patients had FCR tendon exposure of <0.5 cm2. 2/14 had diminished grip strength as compared with the normal contralateral side. 4/14 patients had paresthesias in the early postoperative period, all of which resolved by 4 weeks. CONCLUSIONS: Treatment of the radial forearm flap donor site using Integra™ artificial dermal matrix and autograft is a promising alternative to autograft alone and is possible in a single stage.