Journal of Aesthetic & Reconstructive Surgery

Our Experience with Integra Dermal Regeneration Template (IDRT) and Glabrous Grafting for Plantar Raw Areas

Background: One of the principles of plastic surgery is to replace “like with like”. In situations when flap cover is not feasible for reconstructing the soft tissue defects of the sole, an alternative is to apply IDRT to cover the vital structures (bone, tendon, fascia, nerves, vessels) and cover with glabrous skin graft to the areas of the weight-bearing region. The use of glabrous skin graft holds good with the principle of plastic surgery in replacing like with like. The glabrous graft will act and look like normal plantar skin. There is not much literature available on the use of IDRT with glabrous graft for the reconstruction of plantar raw areas

Materials and methods: The study included 7 patients with raw areas in the plantar aspect of the foot admitted under the Department of Plastic and Reconstructive Surgery at Kasturba Medical College, Manipal between 2021 and 2022. These patients underwent multiple rounds of debridements, IDRT application with NPWT dressing followed by glabrous grafting was done to weight-bearing areas of the foot.

Result: In our study, we used IDRT for exposure of bone, plantar fascia, thinned-out soft tissue, and deep soft tissue defect of the plantar area of the foot. 100% graft take noted in 6 patients and 90% in one patient. Donor sites healed within 2 weeks. Patients were pleased with color match at the recipient site and donor site scar. Patients were able to weight bear by 4 weeks at the recipient site.

Conclusion: The combination of the use of IDRT along glabrous graft can be used for resurfacing the plantar defects, as it covers vital structure and provides an additional layer to the foot the by use of IDRT and use of glabrous graft maintains the ontour of the foot without adding bulk to the foot unlike a flap, which makes ambulation and weight bearing easier and more stability. It also gives better a sensation than a non-neurotised flap. Hence this can be a recommended procedure to be considered for reconstruction of plantar skin defects.

Author(s): Rupika Rajan*, NC Sreekuamar, Joseph Thomas and Mihika Antonia Dean

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