Following successful formation of
the healed wound tissue, typically at around 21 days,
staples or sutures are removed. 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
Assess the availability of donor
sites. Estimate the size of the epidermal graft and
determine if the expanded graft will cover the
INTEGRA Meshed Bilayer Wound Matrix. If
not, then staged or delayed epidermal grafting is necessary.
Remove excess granulation tissue
at seams of INTEGRA Meshed
Bilayer Wound Matrix at edges including any contaminated
or necrotic tissue or areas of incomplete take
Debride surface of the site by lightly
rubbing with a gauze pad if necessary. Control any bleeding.
The tissue does not bleed easily, but may "blush"
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.
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.