Following successful formation of
the healed wound tissue, 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 tissue formation.
Assess the availability of donor
sites. Estimate the size of the epidermal graft and
determine if the expanded graft will cover the
INTEGRA™ Bilayer Matrix Wound Dressing.
If not, then staged or delayed epidermal grafting is
necessary.
Remove excess granulation tissue
at seams of INTEGRA™ Bilayer
Matrix Wound Dressing 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"
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™
Bilayer Matrix Wound Dressing 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.
