Neodermis formation
    Inspection and care of the Neodermis
Movement/outpatient care
    Fluid accumulation
    Premature silicone separation

Purulence/Infection POD 0-12
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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)

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