One-Stage Use of Integra in the Management of a Complex Dorsal Hand Wound in a Patient with Acquired Hemophilia A

Abstract

This case report presents a unique clinical dilemma in the treatment of a large full-thickness dorsal hand wound in a 64-year-old Caucasian woman with recently diagnosed acquired hemophilia A. The wound was instigated by nominal blunt force trauma to the dorsal hand and progressed to a large desquamating bulla. Treatment was initiated by careful evacuation of the bulla and daily dressing changes. The resulting necrosis of the skin produced a loose eschar. Subsequent removal of the eschar left the extensor tendons with minimal hypodermis covering the paratenon. The potential for life-threatening hemorrhage limited treatment options. The wound was treated with Integra Dermal Regeneration Template and planned for delayed definitive coverage. Continued concern for hemorrhage and comorbid conditions delayed skin grafting. Wound surveillance demonstrated notable interval healing ultimately resulting in complete regeneration of the skin, providing full coverage of the wound and no functional deficits without surgical intervention or skin grafting. Key words: acquired hemophilia, hand, Integra, skin, wound