A 67-year-old woman developed foot necrosis due to complications of atherosclerosis. The foot was managed by basic topical care and debridement. Operative revascularization was done (saphenous vein graft to dorsalis pedis artery), and the wound responded with rapid proliferation of granulation tissue. After that, even skin grafts would have healed readily on the simple areas, but complex areas of exposed bones, joints, tendons, and ligaments complicated the coverage issues. Flaps are conventionally needed, local or free, but in an arteriopathic foot wound of this size, they are either not available or have too many potential risks. Integra provides a wound management option for difficult wounds.

The wound was debrided and closed with Integra, shown here 6 weeks after placement and ready for skin grafts.

The foot healed and remained stable, seen here 6 months later.