Following successful formation of
the Neodermis, typically at around 21 days, the patient
is returned to surgery where the silicone layer is removed
and a thin epidermal autograft 0.004-
0.006 inches (0.1016 - 0.1524 millimeters) is placed.
Staples or sutures are removed and
the silicone is peeled back carefully from the edges
with forceps. A spatula or blunt instrument may be used
(if necessary) to perform the separation. Difficult
removal may indicate incomplete Neodermis formation.
Assess the availability of donor
sites. Estimate the size of the epidermal graft and
determine if expanded graft will cover INTEGRA® Template.
If not, then staged or delayed epidermal grafting
is necessary.
Remove excess granulation tissue
at seams of INTEGRA® Template at edges including any
contaminated or necrotic tissue or areas of incomplete
take
Debride surface of neodermis by lightly
rubbing with a gauze pad if necessary. Control any bleeding.
The Neodermis does not bleed easily, but may "blush"
after debridement.
Prepare donor site by infusion with
saline to facilitate harvesting. Harvest a thin epidermal
graft 0.004-0.006 inches (0.1016 - 0.1524 millimeters).
Grafts thinner than 0.004 inches may result in incomplete
"take" as few live epidermal cells are transferred.
Grafts thicker than 0.008 inches are more likely to
leave a residual meshed appearance. The graft should
be attached as per normal surgical unit protocol, taking
the following into account: The graft is more fragile
than conventional split-thickness grafts. The thinness
of the graft makes orientation easy to confuse (Curl
under indicates correct orientation). Carefully smooth
out the graft. Saline can be used to float the graft
into position. Interstices should be larger than 2mm.
Secure by stapling edges and center as appropriate.
Dress and care for epidermal graft sites using the protocols
typically used for thick split-thickness skin grafts.
Similar to dressing INTEGRA® Template
sites, build dressings in layers and immobilize joints
in a flexed position. If the epidermal graft seems to
"disappear", obtain cultures. In some cases,
this is typically the result of the graft being too
thin or the presence of infection. If negative, continue
to dress normally. Engraftment and confluence should
occur within 21 days. If positive for infection, administer
antibiotics and continue to monitor closely. If engraftment
or confluence has not occured within 21 days, then re-grafting
may be necessary.
In order to complete the certification
process, please complete the information
on the Certification Page.
