| Purulence/Infection
POD 0-12 |
|
Remove all signs of possible purulence
- Aspirate or evacuate by incising/rolling
- Treat with topical antimicrobials - Irrigate INTEGRA®
Template sites at seams/edges and beneath the silicone
layer with a topical antimicrobial such as sulfamylon
5 solution/slurry, G-U irrigant, or silver nitrate 0.5%
solution. Irrigate frequently (2-6 times daily).
- Culture and initiate systemic antibiotics based on the
clinical judgement of the practitioner
If aggressive treatment of purulence
is not successful as evidenced by increasing purulence/pus,
non-take of INTEGRA® Template (i.e., a "floating"
sheet) or silicone separation, then the affected area
needs to be removed.
- Remove only the affected area using "windowing"
(remove silicone over area to be treated, creating a "window"),
treat with topical antibiotics
- Treat as open wound until infection is resolved. Once
infection is resolved, apply new INTEGRA® Template sheet
or treat with temporary covers (e.g., allograft ) until
ready to autograft. At time of epidermal autograft, the
granulation tissue should be removed, revealing Neodermis
underneath ready
for grafting.
Areas of Incomplete INTEGRA®
Template Take (i.e., inadequate Neodermis formation) POD
5 or higher
Areas of incomplete take or detachment of the INTEGRA®
Template can result from mechanical dislodgement (due
to shear, improper splinting, PT), infection, hematoma,
granulation tissue formation,
premature silicone separation or damaged matrix.
There are several options for treating areas of incomplete
take depending on the size of the area, the amount of
Neodermis formed and timing (i.e., POD).
- Areas under 2 sq cm should be monitored for infection
but not remove until time of epidermal grafting
- Areas over 2 sq cm should be removed and treated by
either (1) re-application of new INTEGRA® Template or (2)
STSG
- Identification of poor INTEGRA® Template take is identified
by poor color and lack of adherence (lateral movement
of matrix under finger pressure)
