| Purulence/Infection
POD 0-12 |
|
Remove all signs of possible purulence
- Aspirate or evacuate by incising/rolling
- Treat with topical antimicrobials - Irrigate INTEGRA™
Meshed Bilayer Wound Matrix sites at seams/edges and beneath
the silicone layer with a topical antimicrobial such as
sulfamylon 5 solution/slurry, G-U irrigant, or silver
nitrate 0.5% solution. Irrigate frequently (2-6 times
daily).
- Culture and initiate systemic antibiotics based on the
clinical judgement of the practitioner
If aggressive treatment of purulence
is not successful as evidenced by increasing purulence/pus,
non-take of INTEGRA™ Meshed Bilayer Wound Matrix
(i.e., a "floating" sheet) or silicone separation,
then the affected area needs to be removed.
- Remove only the affected area using "windowing"
(remove dressing over area to be treated, creating a "window"),
treat with topical antibiotics
- Treat as open wound until infection is resolved. Once
infection is resolved, apply new INTEGRA™ Meshed
Bilayer Wound Matrix sheet or treat with temporary covers.
If applying an epidermal autograft, the granulation tissue
should be removed, revealing healing tissue underneath.
Areas of Incomplete INTEGRA™
Meshed Bilayer Wound Matrix Take (i.e., inadequate formation)
POD 5 or higher
Areas of incomplete take or detachment of the INTEGRA™
Meshed Bilayer Wound Matrix can result from mechanical
dislodgement (due to shear, improper splinting, PT), infection,
hematoma, granulation tissue formation, premature silicone
separation or damaged matrix.
There are several options for treating areas of incomplete
take depending on the size of the area:
- Areas under 2 sq cm should be monitored for infection
but not removed until time of epidermal grafting
- Areas over 2 sq cm should be removed and treated by
either (1) re-application of new INTEGRA™ Meshed
Bilayer Wound Matrix or (2) STSG
- Identification of poor INTEGRA™ Meshed Bilayer
Wound Matrix take is identified by poor color and lack
of adherence (lateral movement of matrix under finger
pressure)
