Pre Operative Guidelines
  Complete Excision of Non-Viable Tissue
    Uniform and Flat Wound Bed
    Adequate Vascular Supply
    Meticulous Hemostasis
    Infection Free Wound Bed
  Post-Op Care

Excision - Section Summary
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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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