Seven years' experience with Integra as a reconstructive tool
| Autor: | Patricia White, James C. Jeng, Timothy D. Light, Amin D. Jaskille, Julio C. Sokolich, James H. Street, Shaher Khan, Philip E. Fidler, Marion H. Jordan |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
Adult
medicine.medical_specialty Mafenide Adolescent Polyesters Snake Bites Abdominal Injuries Transplantation Autologous Amputation Surgical Abdominal wall Avulsion medicine Humans Surgical Wound Infection Fasciitis Necrotizing Prospective Studies Registries Surgical Flaps Fasciitis Aged Aged 80 and over Skin Artificial business.industry Rehabilitation Avulsion fracture Chondroitin Sulfates Soft tissue Skin Transplantation Length of Stay Middle Aged medicine.disease Bandages Surgery Tendon Transplantation medicine.anatomical_structure Treatment Outcome Case-Control Studies Emergency Medicine Anti-Infective Agents Local Collagen Polyethylenes business Burns |
| Zdroj: | Journal of burn careresearch : official publication of the American Burn Association. 28(1) |
| ISSN: | 1559-047X |
| Popis: | The bilayered dermal substitute Integra (Integra Life Sciences Corp., Plainsboro, NJ) was developed and has been widely used as primary coverage for excised acute burns. Our take has been slightly different, finding it most useful in the management of complex soft-tissue loss and threatened extremities as the result of tendon, joint, or bone exposure. Often tasked to fill significant volume loss, we have become adept at stacked multiple-layer applications. Creative use of this material has resulted in unexpected successes with distal limb salvage; the technique takes its place beside adjacent tissue transfer, composite flaps, and vascular pedicle flaps in our burn reconstructive practice. A prospective registry (44 patients) has been kept during the past 7 years that catalogs wounds with complex soft-tissue loss treated with Integra grafts. Many of these patients were at risk of extremity loss because of exposed tendons, joints, or bone. Integra was applied after 1:1 meshing. With profound soft-tissue defects, multiple layers of Integra were serially applied 1 to 2 weeks apart for reconstitution of soft-tissue contours. Local Integra graft infections were managed by silicone unroofing followed by topical sulfamylon liquid dressings. Wounds addressed included fourth-degree burns, necrotizing fasciitis, pit-viper envenomations, and total abdominal wall avulsion in one patient after being run over by a bus. Patients generally were free of pain from their wounds during the maturation phase of the Integra neodermis. Restoration of tissue contour was significantly better when using multiple layers for deep defects. Second and third layers of Integra were successfully applied after an abbreviated first graft maturation period of 7 days. Epithelial autografts on multilayer Integra applications frequently "ghosted"; they would auto-digest to dispersed cells followed subsequently by the reappearance of a confluent epithelial layer. Final grafted skin morphology over palmar and plantar surfaces assumed the type and fingerprint pattern of the original tissues. Infections were readily visible. Early recognition kept them to easily treated circumscribed areas, which did not jeopardize the entire wound. Lengths of stay were long (range, 2-246 days) but not significantly greater than with traditional techniques. The specific reconstructive use of Integra permitted unexpected salvage of several threatened extremities by protecting exposed tendons, bones and joints. Long-term histologic examination revealed unexpected persistence of Integra collagen. Large volume loss wounds benefited from the ability to fill voids with multilayered applications. |
| Databáze: | OpenAIRE |
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