A 43-year-old man developed multiple complications of rapidly progressive scleroderma. His hands had skin atrophy, sclerosis, and telangiectasias typical of scleroderma. There were multiple contractures and skin lesions. The largest ulcer was on the dorsum of the index finger metacarpophalangeal joint, where loss of the dorsal joint capsule caused direct wide exposure of the joint space and dorsal bone surfaces. As one of the few fingers not contracted and still functional, salvage was important for rudimentary activities. This view, in surgery, shows the open metacarpophalangeal joint and degenerated bone at the base of the phalanx.

These open structures required suitable coverage. Sclerotic skin made local flaps a technical impossibility. Histology showed stenotic fibrotic arteries typical of immunopathic angiopathy, and impaired circulation made any surgery risky. Conventional options for closure, including topical care, repair, flaps, grafts, and amputation, were all too risky, doomed to fail, technically unfeasible, or too destructive of remaining function. Only Integra offered a safe, dependable, sensible solution.

Integra healed the open bones and joint and preserved a functioning finger, shown here at 6 months. The material is compliant enough to allow full flexion. Threats to the finger are gone, and daily function is possible.