Calcified Integra membrane: one possible cause of skin graft failure in the second stage of Integra use

Abstract

The use of Integra as an artificial dermal regeneration template is well established. Following initial use of Integra to resurface the wound bed, the second stage involves removal of the silicone layer and application of a split skin autograft. Previous histological studies have shown that neo-vascularisation of the Integra occurs between 2 and 4 weeks, and therefore, skin grafting over the Integra is recommended at any time after this period. We present a case of an infant with 38% total percentage of body surface area in whom we performed early burn excision and immediate application of Integra. In this case, the second stage of skin grafting was delayed, resulting in the formation of a crusty white membrane over the Integra. Histological analysis with a Von Kossa stain revealed evidence of calcification within the superficial layers of the Integra. Each leg was initially treated differently. In one leg, mechanical scrubbing of this layer was performed. The subsequent results of grafting in this leg were unsatisfactory, and repeat grafting was necessary. In the other leg, tangential excision using a Watson knife was performed before grafting. This produced much better results in terms of skin graft ‘take’. The causes of calcification in biomaterials are discussed, and recommendations are made on the basis of the clinical findings in this particular case.