PO:32:183 | Innovative use of integra dermal regeneration template on systemic sclerosis digital ulcers: a case report

Elena Vanni¹, Martina Orlandi^1|2, Amelia Spinella², Valentina Pinto³, Massimo Pinelli³, Dilia Giuggioli^1|2 | ¹Reumatologia, Università di Modena e Reggio Emilia; ²Reumatologia, Azienda Ospedaliero-Universitaria Policlinico di Modena; ³Chirurgia Plastica, Università di Modena e Reggio Emilia e Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy

Introduction. Digital ulcers (DU) are among the most frequent debilitating manifestations of systemic sclerosis (SSc), causing pain, disability, and impaired quality of life. In refractory cases, surgical procedures, including amputations, may be required. Integra® dermal regeneration template is a bilayer acellular dermal substitute composed of a porous collagen–glycosaminoglycan matrix and a temporary silicone layer. Although originally developed for burns and complex wounds, it has been increasingly used in reconstructive surgery. We report the first case of combined use of Integra and autologous fat grafting (AFG) for the treatment of refractory DUs in a patient with SSc.

Case Report. A 45-year-old woman with diffuse cutaneous SSc (anti-Scl70 positive, mRSS 22), severe skin involvement, Raynaud’s phenomenon with digital resorption, esophageal and pulmonary disease, presented with refractory DUs despite maximal vasodilatory therapy (Iloprost, Selexipag, Bosentan) and immunosuppressants (MTX, RTX, MMF). She had previously undergone partial digital amputations and one AFG. In March 2025, due to progression of disease with multiple hard-to-heal DUs (Figure 1), a combined surgical approach was planned, consisting of debridement, Integra application to three digits of the right hand (I, II, IV), and bilateral AFG. The procedure, performed under local anesthesia, consisted of two phases: 1. Integra application: after surgical debridement, the matrix was hydrated, positioned, and sutured to wound margins with absorbable stitches (Figure 2). 2. AFG: adipose tissue was harvested by liposuction, purified by centrifugation, and injected into the hands at subcutaneous and perilesional levels. The fat, rich in mesenchymal stem cells (MSC), was distributed to dorsal and palmar aspects of all fingers and interdigital spaces. The postoperative course was uneventful. The silicone layer was removed after 10 days, revealing correct matrix integration and well-formed granulation tissue. At the 2 months follow-up, near-complete re-epithelialization in the II and IV digits was achieved while progressive healing of the I digit was noted (Figure 3). Moreover, a reduction of pain (mean numeric rating scale 7.3±1.9 at baseline versus 2.9±1.4 at follow-up) along with significant improvement in hand function was reported by the patient. Conclusions. Integra showed efficacy in providing structural support for skin regeneration even in SSc, where vascular impairment often compromises healing. It appeared beneficial in reducing contamination, promoting fibroblast migration, neovascularization, and neodermis formation. This case suggests that Integra may represent a promising therapeutic option for refractory DUs in SSc, particularly when combined with AFG, which provides regenerative, angiogenic, and immunomodulatory effects through MSC contained in adipose tissue.