Product Description and Benefits
  Indications for Use
  Product Makeup/Histology
  Clinical Sequence
    Venous Stasis Ulceration
    Ulceration to both feet and anterior ankles
    Traumatic degloving calcaneal fracture
    Stump Salvage
    Achilles Ulcer
    Exposed Bone
    Chronic Venous Ulceration
    Immunopathic Wound
    Exposed Joint
    Limb Salvage
    Leg Ulceration
    Arterial Disease
    Hypercoagulable Disorder
    Ankle Ulcer
    Ischemic Ulceration
    Forefoot Ulceration
    Heel Ulcer

Trans-Metatarsal Amputation
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This patient is an 82-year-old white male who burned himself while attempting to soak his foot (in boiling water). He sustained a severe burn that resulted in gangrenous changes to all digits and instep, while sparing the ball of the foot

Electrical/flame burn to neck

Following bypass surgery, a guillotine type trans-metatarsal amputation was performed

Fascial excision of chest

Without a viable plantar flap, the patient needed anterior skin coverage over exposed tendon and bone. INTEGRA™ Bilayer Matrix Wound Dressing was applied over the exposed tissue

INTEGRA® Dermal Regeneration Template

Application of a split thickness skin graft three weeks later

Elastic net dressing

One month later, the patient was ambulating in a darco wedge shoe. Four months post op, the patient was seen in the hospital for unrelated medical reasons, ambulating without problem. The skin over the TMA site was not adhered to the underlying tissues, allowing a reduction of surface tension, possibly aiding in the prevention of breakdown at the amputation site

2 years post trauma

Cases Courtesy of:
Dave Granger D.P.M., Kevin Roberts D.P.M., Richard Jay D.P.M., Mark Mantell M.D., Paul Glat, M.D.
The Graduate Hospital Wound Care Center, Philadelphia, PA 19146

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