Integra dermal regeneration template is commonly used in the developed world. This case history documents the application of Integra for the first time in Gaza, Palestine. This single case history illustrates how a tried and tested technique can be imported to a more challenging environment. The emphasis in this case history is not to recount a well-known technique of Integra application but to outline how the environment has to be prepared and the surgeon adapt to minimise risk and maximise the chances of success. This first application of Integra in Gaza illustrates the importance of starting with simple cases when a technique is being piloted in an austere environment. Patient selection, local theatre set up, staff and surgical technique, as well as patient follow-up facilities, all need consideration before doing the first trial of even this most established of products in a new environment.