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Case Study
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Use of Integra¨ and subsequent skin grafting in difficult wounds Karl J. Hekimian, MD, Crysty Frick, BSN, Mario Lluria, BSN, Vanessa Garcia, Carondelet St. Mary's Hospital, Tucson, AZ Unhealthy wounds, such as radiation burns, pressure sores and wounds with exposed bone or tendon can be difficult and often require major surgical flaps and prolonged hospital courses. Initial placement of Integraâ on wounds provides a healthy layer of autologous deep tissue. Integraâ is a bioengineered bilaminate skin substitute originally developed for use in burns, has a deep layer made of collagen and chondroitin that serves as a matrix for dermal regeneration and an outer layer of thin silicone sheet. When placed on an open wound, the Integraâ ÒtakesÓ by invasion of cells and ingrowth that eventually replaces the deep layer with dermis-like autogenous tissue, allowing the silicone layer to slough off. This allows subsequent closure with simple skin grafts in areas typically considered not amenable to skin grafting such as over bone or tendon. It can also provide additional bulk to areas where more padding is needed, such as over a bony prominence. Additionally, it can be used on patients who are not candidates for major procedures such as muscle flaps or free flaps due to health or compliance issues. Reconstruction can often be done on an outpatient basis or require only 1Ð2 days in the hospital. This poster shows cases of successful healing obtained with this technique in recurrent stasis ulcers, radiation burns with exposed tendon, non-healing traumatic ulcers, ulcers with exposed bone, infected joints and pressure ulcers are presented. Gottlieb ME, Furman J. Successful management and surgical closure of chronic and pathological wounds using Integra. J Burns Surg Wound Care. 2004;3(1):4. |
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