Integra is a tool of soft tissue reconstruction developed by Yannas and Burke inthe late 1970s. It is made up of an outer layer of silicone and an inner dermal layer ofcrosslinked bovine tendon collagen with glycoaminoglycan chondroitin-4- sulphate and chondroitin-6- sulphate, a scaffold for infiltration of recipient fibroblasts. It is a template for the formation of neodermis which is histologically similar in appearance and structure to normal dermis. Skin grafting is performed on neodermis 2-3 weeks later or in one stage procedure. This technique was initially developed to treat extensive burns with limited donors, later extended to scar contracture, and to wounds in tendons and bone exposure. However, the clinical benefits of Integra remain controversial, and its role in the ladder of reconstruction remains to be determined. The speech entitled “Clinical applications of Integra in difficult wounds” focuses on the author personal experiences of using Integra over the past 19 years on chronic wounds or extensive deep burns with bones or tendon exposure. Ultimately, the role of artificial dermis in the ladder of reconstruction will be discussed.