|INTEGRA in Reconstructive
Surgery - Summary
In this section, you have learned:
- In the first surgical procedure the
wound is excised to viable tissue and INTEGRA Template
is applied. Over the next 2-3 weeks, typically 14-28
days, the dermal layer is regenerated while simultaneously
degrading the collagen-GAG matrix. The biodegradable
template induces organized regeneration of normal dermal
tissue ("Neodermis") by the body. In the second
surgical procedure following dermal regeneration, the
silicone layer is removed and a thin epidermal autograft
0.004-0.006 inches (0.1016 - 0.1524 millimeters) is applied. As shown, engraftment
and confluence of the epidermal graft complete the process
in about 30 days from the first procedure.
- In excision, we stressed that an
excised graft bed must be free from contamination and
infection. All affected tissue must be removed. You
must achieve an adequate vascular supply prior to the
application of INTEGRA Template. Meticulous hemostasis
also needs to be achieved to prevent hematomas or excessive
fluid accumulation. To ensure intimate contact with
INTEGRA Template the graft bed must be uniform and flat.
The graft bed must be dry with no signs of bleeding.
You should achieve level tissue planes and when necessary,
marsupializing edges to avoid large step-offs between
the wound bed and normal skin.
- In the application section, you learned
to estimate the number and size of sheets, and anticipate
when the product will be needed. you can mesh sheets
1 : 1 through a "non-crushing" mesher but
do not expand. Do not try to move or "float"
sheets like a STSG, instead, lift sheets up and reposition.
Place sheets on excised wound bed, staple parallel to
inside edge of wound bed and trim excess. Fix sheets
independently and/or staple adjacent sheets together
to minimize gaps, reducing granulation tissue formation.
It is recommended that dressings be built in layers
while checking under dressings more frequently.
- In section 3, post-op care, you learned
how each dressing is designed to perform a specific
function. Ultimately, the goal of the dressings is to
protect the grafts by preventing shearing and dislodgement,
while still enabling routine visual examination. Dressings
should be built in layers to protect the INTEGRA Template
site from shear and infection. The adjunctive use of
bolsters and splints help achieve intimate contact with
the wound bed and immobilize graft sites. You should
inspect INTEGRA Template by checking seams, interstices,
and edges for signs of hematomas, infection, fluid accumulation,
silicone layer separation, and areas of non-take on
a regular basis.
It is important to plan your strategy for moving the
patient ahead of time. Your visual inspection regimen
should include recognition of maturing Neodermis as
well as the ability to identify the various complications
that may arise.
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