Placement Of Integra Research Articles

Term Neonate Born With Right Upper Extremity Skin Necrosis at Birth: A Case Report.

Congenital skin and soft tissue necrosis is a rare condition associated with significant morbidity and mortality in neonates. The authors treated a neonate born with significant skin necrosis of the right forearm. The case report is followed by a literature review and discussion of previously published reports of neonatal skin necrosis. A term female neonate was admitted to our hospital at 24 h of age for skin necrosis of the right forearm with sloughing and edema below the right elbow and contractures of her fingers. Topical treatment with cleansing and antibiotic application was initiated. The LUNA florescent microangiography showed superficial perfusion defects in the arm and dorsum of the hand along with overt ischemia over the dorsal aspect of the forearm. She was treated with intravenous antibiotics following a sepsis evaluation. Subsequently, she developed hypotension treated with fluid boluses, dopamine, and stress dose steroids. Concerns of wound infection and sepsis led to debridement of the necrotic area within the first 24 h post-admission. Wet-to-dry dressing changes using Vashe wound solution were begun postoperatively.; followed by placement of Integra on postoperative day-of-life (DOL) 7; dressing takedown on DOL 12; and autografting of the right hand and forearm with disarticulation of the 4th distal interphalangeal joints and right 5th distal interphalangeal transection on DOL 24. Postoperative dressing care was continued during the remainder of the hospital stay, she remained stable without any further complications and was discharged home on DOL 34 with outpatient clinic follow-up.

The use of Integra Dermal Regeneration Template in the surgical management of revision penile inversion vaginoplasty: A case series

Since its initial design and use for the temporary coverage of severe full-thickness burn defects, Integra® (Integra LifeSciences) Dermal Regeneration Template has been increasingly used all over the body, yielding successful results in coverage of wound beds with insufficient vascularity and suboptimal conditions for proper healing. In this study, we report an institutional case series and outcomes of gender-affirming vaginoplasty revision for vaginal lengthening or reopening of the canal via placement of Integra® to assist in optimizing the wound bed for subsequent skin grafting when wound conditions were deemed to be suboptimal. A retrospective chart review was conducted in patients who underwent this technique by a single surgeon (JM) at the authors' institution. Demographics, vaginal depth, and complications were recorded and compared. Our patient population thus far includes 178 primary vaginoplasties, of which 9 of those needing revision were treated with this approach. The age at revision mean was 47±13.5 years, and the body mass index mean was 31±4.1. All patients had comorbidities and five were former smokers. Eight patients had prior revision conducted without Integra®, with a mean of 1.89±1.76 and the time to first revision mean was 15.89±14.2 months. No long-term complications after Integra® reported and most of the patients did not require further revision. The follow-up mean was 8.48±8.66 months. A mean of 6.77±5.35cm was gained after the Integra® revision (4.92±4.1cm before versus 12.54±3.07cm after). The final depth after Integra® + full-thickness skin graft mean was 13.34±4.65cm. Overall, the depth gain mean was 7.48±5.77cm; in total, seven patients gained depth after revision with an average of 78% skin graft take. Overall, Integra® presents an alternative option for revision vaginoplasty with complicated wound beds potentially aiding in the healing process before grafting.

803 Management of An Intra-Oral Resection with Integra® Dermal Regeneration Template – Worth A Bite?

Abstract Introduction There are a spectrum of treatment options available for reconstruction of oral mucosal defects including secondary healing, skin grafts, local flaps and microvascular free flaps. We present the use of an alternative intra-oral reconstruction with Integra® Dermal Regeneration Template. Case Report An 85-year-old patient with a severe gag reflex and history of oral cancer presented with biopsy proven severe dysplasia of the right palate extending to the hamular notch. She was treated with wide local excision, extraction of teeth, buccal fat pad advancement for closure of an oral-antral communication and placement of Integra® Dermal Regeneration Template. Discharge was possible the same day as the patient was able to eat and had minimal pain. Discussion Integra® Dermal Regeneration Template is a bilayer wound matrix consisting of silicone in the outer layer with bovine collagen and glycosaminoglycan from shark cartilage in the inner layer. Oral cancer predominantly affects the older population, and this method can reduce surgical time, remove donor site pain, reduce post-operative pain and avoid use of a cover plate where a strong gag reflex was present. The area heals quickly and aids quick restoration of oral function. Conclusion Integra® Dermal Regeneration Template has been used for head and neck defects with good outcomes. It is being increasingly used intra-orally with good outcomes, suggesting a further application of the material with advantages over traditional techniques in specific patient groups.

Integra®-Dermal Regeneration Template and Split-Thickness Skin Grafting: A Therapy Approach to Correct Aplasia Cutis Congenita and Epidermolysis Bullosa in Carmi Syndrome.

The association of junctional epidermolysis bullosa with pyloric atresia (JEB-PA) and aplasia cutis congenita (ACC) was described by El Shafie et al. (J Pediatr Surg 14(4):446–449, 1979) and Carmi et al. (Am J Med Genet 11:319–328, 1982). Most patients die in the first weeks of life, and no curative treatment options are available so far. We describe a patient with JEB-PA and ACC (OMIM # 226730) who was treated for extensive areas of ACC by Integra®-Dermal Regeneration Template and split-thickness skin grafting (STSG). Clinically, the dermal template changed into well-vascularized neodermis, and after STSG, full take of the transplants was detected. No infections of the huge ACC areas were seen. Further studies must validate this treatment option in severe and acute cases of JEB-PA with ACC. Based on clinical findings, we postulate that placement of Integra®-Dermal Regeneration Template with STSG could be a new treatment option for patients having JEB-PA with ACC to prevent severe infection, compartment-syndrome-like conditions, and deformities. Based on literature findings, we assume that Integra®-Dermal Regeneration Template with STSG could even be able to prevent new blistering and thereby be a treatment option in cases of ACC and JEB.

Malignant granular cell tumor of the back: a case report and review of the literature.

Malignant granular cell tumors are rare, intensely aggressive entities. This paper presents a case of a large rapidly recurrent malignant granular cell tumor with regional and distal metastases on the back of a 54-year-old Cuban man. The primary tumor recurred within six months of the original wide local excision and with satellite lesions apparent at twelve months, and the mass was diagnosed using the histological criteria established by Fanburg-Smith et al. for malignant granular cell tumors. By fifteen months, right axillary lymphadenopathy, multiple satellite lesions, pulmonary nodules, and distant metastasis in the right thigh were present. At sixteen months, wide local excision of recurrent mass and local satellite masses along with right axillary dissection and placement of Integra with subsequent split-thickness skin graft were performed by surgical oncology and plastic surgery teams. The surgical specimen measured 32.0 × 13.5 × 5.5 cm, containing multiple homogeneous masses with the largest mass 22.0 × 9.0 × 4.6 cm. Following surgery, patient was started on Pazopanib 800 mg/day based on phase III randomized trial data in the treatment of soft tissue sarcomas showing this as a potential novel therapy for malignant granular cell tumors.

The Use of Integra® Dermal Regeneration Template in the Reconstruction of Traumatic Degloving Injuries

Traumatic soft tissue, or "degloving" injuries from trauma are common. These injuries are a result of shearing and disrupt tissue planes, such as the junction between muscle and bone. Traditional repair involves debridement followed by skin grafting or flap reconstruction. Many degloving injuries, however, extend to bone or tendon and the decreased vascularity of the wound bed can compromise the success of traditional repairs. Additionally, medical comorbidities make some patients poor candidates for flap reconstruction. The purpose of this study was to evaluate the success of a dermal regeneration template in the treatment of complex traumatic degloving injuries at an American College of Surgeons verified Level 1 Trauma Center. A retrospective review was conducted on all patients sustaining traumatic degloving injuries from January 2009 to July 2010, who were treated with Integra Dermal Regeneration Template followed by split-thickness autografting. Medical records were reviewed and patient demographics, injury characteristics, comorbidities, hospital course, and outcomes were summarized. Ten patients were studied. All had traumatic degloving injuries of an extremity ranging from 50 to 1000 cm. Nine had injuries extending to bone and/or tendon. After debridement, patients underwent placement of Integra followed by a split-thickness skin graft. Of the 10 patients nine had complete take of their grafts with excellent cosmetic and functional results. Degloving injuries are common in trauma. These injuries often extend to tendon and bone, which poses challenges to repair because of decreased vascularity. Placement of a dermal regeneration template followed by a split-thickness autograft is a viable alternative to traditional methods of repair.

Use of Integra and Interval Brachytherapy in a 2-Stage Auricular Reconstruction After Excision of a Recurrent Keloid

Keloids present a formidable clinical challenge. Surgical excision in conjunction with radiation therapy may decrease the chance of keloid recurrence. Split-thickness skin grafts, however, are more prone to failure in the setting of radiation. In this report, we present a patient with a recurrent auricular keloid who underwent excision and immediate Integra (Integra LifeSciences, Plainsboro, NJ) application, followed by high-dose rate brachytherapy and interval split-thickness skin graft placement. A 23-year-old woman with a history of a recurrent auricular keloid after previous surgical excision, corticosteroid injection, and radiation underwent reexcision of her keloid. Integra was used to cover the resultant exposed auricular perichondrium. The patient then received high-dose rate brachytherapy (1500 cGy) on postoperative days 1 and 2, followed by definitive split-thickness skin graft placement 3 weeks after her initial surgery. The patient recovered from all interventions without complication. There was no evidence of keloid formation 27 months after the interval split-thickness skin graft placement at either the auricular recipient or thigh donor sites. We report the first case of a 2-stage reconstruction of a recurrent auricular keloid (composed of keloid excision and placement of Integra in conjunction with high-dose rate brachytherapy, followed by interval split-thickness skin grafting), resulting in an acceptable cosmetic result without evidence of recurrence at long-term follow-up.

The use of acellular dermal regeneration template for recalcitrant pilonidal disease

Numerous techniques have been described for the treatment of pilonidal disease, yet there remains no consensus on the optimal management of recurrent pilonidal disease. Pilonidal wounds often lack the structural integrity to heal over and Integra provides a scaffold for the regrowth of an autogenous dermis from the patient's own fibroblasts and collagen. Postoperative negative pressure wound therapy (NPWT) may speed vascularisation of Integra, re-epithelialisation, and wound closure. This case report concerns two patients with chronic pilonidal sinuses who underwent wide excision and placement of Integra with postoperative NPWT. Postoperatively, the patients were assessed for complications and recurrence. Both patients went on to heal and did not require further surgical treatment after a median follow-up of 29months. Integra may help prevent pocket or cyst formation during the closure process and provides a neodermis, allowing for full re-epithelialisation. More research and a longer follow-up are needed to evaluate the role of Integra and NPWT in recurrent pilonidal disease.

Incidence et microbiologie des complications infectieuses lors d’utilisation de la peau artificielle Integra ® chez le brûlé

Integra dermal substitute is used as biomaterial after thermal injury. This artificial skin allows temporary coverage after burns excision, transformation of matrix in neo dermis and definitive engraftment. Infections are the most common complication of this technique. The objectives were to evaluate incidence of sepsis, to analyse microbiology and risk factors of developing Integra infections. Patients with acute burns and indications of Integra during five years were retrospectively enrolled. Demographic data, surgical procedures and microbiologic biopsies were collected. Fifty patients (40 + or - 15 years) were studied and 71 surgical procedures using Integra were performed. Burns were extended 45 + or - 21% total body surface area. Placement of Integra was made 15 + or - 11 days after burns and autografts 31 + or - 9 days after placement of Integra. Twenty-one patients had infected Integra (42% of population). A total of 23 Integra infected sites were observed (15 local and eight invasive). Diagnosis of infection was made after 13 + or - 5 days using quantitative cultures. Other sites of infection were respiratory tract (46 pneumonias) and others burned wounds (17 infections outside of Integra. Any risk factor was identified between burns who developed Integra infections and the others. Incidence of infected Integra was higher than in previous studies. Delayed application of Integra after burns could explain higher incidence of infection. Pseudomonas aeruginosa and Staphylococcus aureus were more frequently isolated than other pathogens. Standardized technique for wounds coverage with Integra is necessary to reduce incidence of infections and improve functional results in burns patients.

Integra in Lower Extremity Reconstruction after Burn Injury

Standard care for lower extremity injuries with exposed bone or tendon is vascularized tissue transfer. In patients with deep and extensive burn injuries, these options are often not available or for various reasons are technically difficult. The advent of Integra, a permanent dermal replacement matrix, provides an important alternative to the traditional reconstructive choices. The authors report seven patients, with a total of nine lower extremity injuries, from the Los Angeles County and University of Southern California Hospital Burn Unit treated from September of 2001 to January of 2003 who presented with complex burn injuries involving their lower extremities with tendon, open joints, and/or bone exposure. All seven patients were treated initially with tangential excision of the burn eschar and placement of Integra. After engraftment, epidermal coverage was restored with a thin split-thickness skin graft. This treatment provided stable wound coverage, and none of the patients have required further surgical procedures to maintain wound closure. The use of a bioengineered, cell-free dermal matrix expands reconstructive options and allows salvage of extremities that might otherwise have been amputated or required prolonged, staged procedures. The authors' experience shows that Integra provides a sound alternative option for providing durable coverage of vital lower extremity structures. It should be considered as part of the lower extremity wound coverage algorithm.

TREATMENT OF A RECURRENT AND INTRACTABLE KELOID WITH EXCISION AND PLACEMENT OF INTEGRA DERMAL MATRIX: RESULTS AND RATIONALE.

Introduction Integra dermal matrix (Integra Life Sciences Corp., Plainsboro, NJ), introduced by Burke and Yannas in 1981, has been well established as an efficacious treatment option in the management of burn injuries. Its use has expanded beyond burn surgery to include other situations where full-thickness skin coverage is necessary. The acceptable cosmetic results commonly obtained through the use of Integra have prompted research into additional areas where minimal scarring is a priority. Case Description A 47-year-old African American male with a large recurrent keloid of the upper chest and lower neck region underwent surgical excision of the keloid and placement of Integra without the need for subsequent skin grafting after multiple other treatment modalities had failed. At 1 year postoperatively there were no indications of keloid recurrence and the regenerated dermal tissue demonstrated smoothness, pliability, and other acceptable cosmetic features characteristic of the use of Integra. Discussion Integra is produced as a type I collagen and chondroitin-6-sulfate matrix, which plays a significant role in reducing the inflammatory response to the wound. This prevents fibroblast activity from accelerating beyond the control of the wound repair mechanisms and in turn prevents the formation of excessive scar tissue. Immunologic studies have shown that the specific combination of collagen and chondroitin-6-sulfate results in a dampened immune response, thereby lowering the inflammatory drive. In addition, histologic studies have shown that chondroitin-6-sulfate prevents platelet aggregation and degranulation by blocking the platelet binding sites on the collagen fibers. Without this important first step in the inflammatory response the wound healing process can proceed at a self-regulating pace without the resulting hypertrophic scarring or keloid formation.

Management of facial burns with a collagen/glycosaminoglycan skin substitute—prospective experience with 12 consecutive patients with large, deep facial burns

Management of deep facial burns remains one of the greatest challenges in burn care. We have developed a protocol over the past 20 years for management of facial burns that includes excision and coverage with thick autograft. However, the results were not perfect. Deformities of the eyelids, nose and mouth as well as the prominence of skin graft junctures demonstrated the need to explore novel approaches. Integra ® has been used with success in the management of burns of the trunk and extremities. The purpose of this study was to prospectively evaluate the aesthetic outcome of the use of Integra ® for deep facial burns. Twelve consecutive patients underwent excision of large, deep facial burns and placement of Integra ®. Integra ® provides excellent color and minimally visible skin graft junctures. The texture is good but not as supple as thick autograft. Integra ® is not well suited for use in the coverage of eyelid burns due to the need to wait 2 weeks for adequate vascularization. In summary, thick autograft remains the gold standard for deep facial burns. However, for patients with extensive burns and limited donor sites, Integra ® provides an acceptable alternative.