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  Excision
 
  Intra-Operative guidelines
    Estimating the Number and Size of Sheets
    Product Preparation
    Meshing and Handling
    Placement, Shaping and Cutting
    Stapling and Suturing
    Dressing
 
  Post-Op Care
Summary
   


Application - Section Summary
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In this section, you have learned:

  • 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. 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.
  • 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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