| Excision - Section
Summary |
|
In this section, you have learned:
- An excised graft bed must be free
from contamination and infection. All eschar, necrotic
and devitalized tissue must be removed. Pre-Operative
routines should follow normal surgical center protocols.
This may include the use of systematic broad spectrum
antibiotics. If wound infection is detected, treat topically
and/or systemically according to burn unit protocols.
- Early and complete excision (typically
within 24 to 72 hours of injury should be performed).
It is also preferable to have a "safety" zone
between the INTEGRA® Template and the remaining
burn eschar. The "safety zone" should be 2-4
centimeters wide.
- Achieve an adequate vascular supply
prior to the application of INTEGRA® Template. As with
autograft: punctate, uniform capillary bleeding indicates
adequate excision of the devitalized tissue. Signs of
a viable graft bed include: white dermis, pure yellow
fat and glistening fascia.
- The graft bed must be dry with no
signs of bleeding. Meticulous hemostasis needs to be
achieved to prevent hematomas or excessive fluid accumulation.
Epinephrine, pinpoint electrocaudary, thrombin spray,
thrombin-soaked gauze or other topical hemostats should
be used. Avoid broad area cauterization which can lead
to devitalized tissue.
- To ensure intimate contact with INTEGRA®
Template the graft bed must be uniform and flat. Achieve
level tissue planes and when necessary, marsupializing
edges to avoid large step-offs between the wound bed
and normal skin.
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