|Application - Section
In this section, you have learned:
- When preparing for the application
of INTEGRA® Template, plan for complete excision
within 1-3 days post burn.
- Estimate the number and size of sheets,
and anticipate when the product will be needed. Begin
rinsing sheets no later than 15-20 minutes before excision
has been completed. Follow product preparation protocol
as outlined in this course. When removing the INTEGRA®
Template from the foil pouch use gloved hands (do not
use instruments). Rinse each sheet for a minimum of
5-10 minutes in each of the first two basins. Also be
sure to change the saline after every 1-2 sheets, or
as needed. The detectable odor of alcohol should subside
when finished rinsing.
- If meshing INTEGRA® Template
use 4 x 10 inch sheets to avoid folding. Mesh sheets
1 : 1 through a "non-crushing" mesher but
do not expand. DO NOT re-mesh the pre-meshed product.
This technique minimizes fluid accumulation under the
graft, minimizes amount of graft loss in the event of
hematoma and minimizes the risk of graft loss in the
event of bacterial colonization.
- When placing, shaping and cutting
the INTEGRA® Template gently "scoop
out" sheets from the holding basin with gloved
hands and place directly onto the wound bed. 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; or, place sheet on excised
wound bed, trim sheet to fit site, and staple perpendicular
to seam (this allows staples to be placed across seams).
Cut sheets to avoid gaps and overlaps and be sure to
place seam lines along Langer's Lines to reduce risk
of contracture. Make sure INTEGRA® Template
lays flat with no wrinkles or bubbles.
- In a staged procedure, do not place
INTEGRA® Template in contact with un-excised
necrotic tissue, rather maintain a safety margin between
the excised wound bed and any non-excised necrotic tissue.
- Stapling or suturing may be used
when applying INTEGRA® Template, however
with either technique remove all air bubbles. Fix sheets
independently and/or staple adjacent sheets together
to minimize gaps, reducing granulation tissue formation.
Interrupted stapling (i.e., leaving a 1-2 centimeter
space between staples) can be used to seal edges.
- It is recommended that dressings
be built in layers while checking under dressings more
frequently. The elastic net dressing can be attached
by staples or other suitable methods. It will be left
in place until the silicone is removed. When applied
correctly, the expanded interstices will be open about
1-2 cm and the silicone will have slight indentations
from the elastic net dressing.
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