Post-Op Care

INTEGRA in Burn Surgery - Summary
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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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