Seven Yearsʼ Experience With Integra as a Reconstructive Tool

Abstract

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.

Effect of Porcine Small Intestinal Submucosa on Acute Full‐Thickness Wounds in Dogs

“…[10][11][12] In people, collagen-based dermal substitutes followed by an epidermal autograft, or more recently bioengineered bilayered skin substitutes [13][14][15][16] provide the closest product to the ideal wound dressing. [17][18][19] In veterinary medicine, biological wound dressings such as allogeneic peritoneum, 20 amnion, 21,22 omentum, [23][24][25] collagen dressings, 26,27 and more recently extracellular matrix (ECM) products 20,28,29 have been used to treat open wounds in dogs and horses with mixed success.…”

Colgajo paraescapular en pérdidas postraumáticas de tejidos blandos de las extremidades. [Parascapular flap in post-traumatic soft-tissue loss at the limbs.]

“…En once casos, se recurrió a injerto de piel para cubrir áreas expuestas, pero que no necesitaban de cobertura con colgajo libre y estaban contiguas al área lesionada que se cubrió con el colgajo paraescapular; en uno de estos casos, se asoció un sustituto dérmico (Integra®). 10 Diez pacientes tenían exposición de la articulación; otros seis, fracturas expuestas y uno requirió el uso de cemento con antibiótico para rellenar un defecto óseo. En un paciente con una lesión localizada en el tercio de la pierna, tobillo y pie, con pérdida ósea segmentaria del primer metatarsiano, se efectuó un injerto libre de peroné para su reconstrucción en el mismo acto quirúrgico.…”

Epitelización inducida por células troncales derivadas del tejido adiposo

“…En la actualidad, el rango de aplicaciones se ha extendido a otras situaciones clínicas, como la resección de nevus gigantes o la cobertura de lesiones de cuero cabelludo y tendones expuestos (3,4). Integra ® consiste en una matriz de colá-geno tipo I bovino y glicosaminoglicanos de cartílago de tiburón que conforman una estructura porosa cubierta con un lámina de silicona.…”