Long-term Outcomes of Neonatal Hand Sarcoma Reconstruction With Integra and Full-thickness Skin Grafting

Soft-tissue sarcomas of the hand present significant reconstructive challenges. This is due to the complex anatomy and function of the hand, as well as limited local tissue availability. Reconstruction in pediatric patients adds further intricacy because of growth considerations. We present more than 10 years of follow-up of a neonatal congenital fibrosarcoma of the volar hand managed with a dermal regeneration template followed by skin grafting. After neoadjuvant chemotherapy and wide excision, a large full-thickness defect remained. Integra (Integra LifeSciences, Princeton, NJ) was applied for temporary coverage; however, wound vacuum-assisted closure was not feasible due to the patient's age. A split-thickness skin graft was initially placed but demonstrated graft loss. After debridement and thorough wound bed preparation, a full-thickness skin graft was successfully applied, providing stable, durable coverage. Long-term follow-up through skeletal maturity demonstrated excellent hand function, strength, sensation, and range of motion comparable to the contralateral side. The reconstruction had satisfactory cosmesis without hypertrophic scarring, contracture, or abnormal tissue growth at the level of the graft. The graft integrated smoothly with adjacent normal palmar tissue. Staged reconstruction using a dermal regeneration template followed by full-thickness skin grafting can achieve durable, functional, and aesthetic outcomes in pediatric oncological hand defects. Although intended as temporary coverage, Integra ultimately served as a satisfactory component of the definitive reconstruction.