|INTEGRA in Burn Surgery
In this section, you have learned:
- In the first surgical procedure the
wound is excised to viable tissue and INTEGRA Template
is applied. Over the next 2-3 weeks, typically 21-30
days, the dermal layer is regenerated while simultaneously
degrading the collagen-GAG matrix. The biodegradable
template induces organized regeneration of normal dermal
tissue ("Neodermis") by the body. In the second
surgical procedure following dermal regeneration, the
silicone layer is removed and a thin epidermal autograft
0.004-0.006 inches (0.1016 - 0.1524 millimeters) is applied. As shown, engraftment
and confluence of the epidermal graft complete the process
in about 30 days from the first procedure.
- In section 2, excision, we stressed
that an excised graft bed must be free from contamination
and infection. All eschar, necrotic and devitalized
tissue must be removed. Early and complete excision
(typically within 24 to 72 hours of injury) should be
performed. You must achieve an adequate vascular supply
prior to the application of INTEGRA Template. Meticulous
hemostasis must also be achieved to prevent hematomas
or excessive fluid accumulation. To ensure intimate
contact with INTEGRA Template the graft bed must be
uniform and flat. The graft bed must be dry with no
signs of bleeding. You should achieve level tissue planes
and when necessary, marsupializing edges to avoid large
step-offs between the wound bed and normal skin.
- In section 3, application, you learned
to 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. You can mesh sheets
1:1 through a "non-crushing" mesher but do
not expand. 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. Fix sheets
independently and/or staple adjacent sheets together
to minimize gaps, reducing granulation tissue formation.
It is recommended that dressings be built in layers
while checking under dressings more frequently.
- In section 4, post-op care, you learned
how each dressing is designed to perform a specific
function. Ultimately, the goal of the dressings is to
protect the grafts by preventing shearing and dislodgement,
while still enabling routine visual examination. Dressings
should be built in layers to protect the INTEGRA Template site from shear and infection. The adjunctive
use of bolsters and splints help achieve intimate contact
with the wound bed and immobilize graft sites. You should
inspect INTEGRA Template by checking seams, interstices,
and edges for signs of hematomas, infection, fluid accumulation,
silicone layer separation, and areas of non-take on
a regular basis. It is important to plan your strategy
for moving the patient ahead of time. Your visual inspection
regimen should include recognition of maturing Neodermis
as well as the ability to identify the various complications
that may arise.
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