The Use of Artificial Skin Substitute (IntegraTM) in Complicated Non-burn Wounds.
James C. Yuen, M.D.1, Julio Hochberg, M.D.2.
1University of Arkansas for Medical Sciences, Little Rock, AR, USA, 2Marshfield Clinic, Marshfield, WI, USA.
PURPOSE: Integra, initially developed for primary coverage of acute burns, act as a network for dermal regeneration. This technology has been applied to non-burn cases for treatment of complicated wounds: chronic wounds, post-radiation wounds, and wounds with exposed bone and tendons. While this technology was developed for burn wounds, off-label use of this artificial skin substitute has not been popularized for complicated, non-burn wounds. Our experience with IntegraTM will be presented to demonstrate the usefullness and limitations of this artifical skin substitute.
METHODS: We present a retrospective series of 75 patients who underwent IntegraTM reconstruction of complicated non-burn wounds. Both traumatic and chronic wounds underwent serial debridement until each wound is judged to be clean, free of necrotic tissue, local wound sepsis, or erythema. IntegraTM is grafted at this point and dressed with a bolster, followed by approximate weekly dressing changes. After application of this skin substitute, the silastic membrane is removed at 3.5 to 5 weeks later, and the neo-dermis is then grafted with split or full-thickness skin graft. Average age was 39.5 years and mean wound size 44 sq cm. Distribution was upper extremity 28, lower extremity 42, head/neck 5, and trunk 1. Causes were trauma 48, infection 4, tumor ablation 6, radiation 5, venous stasis 1, and chronic wounds and others 12. Average follow-up period was 22 months in 73 patients.
RESULTS: Infections occurred in 13 cases. Of these, 8 cases were minor or superficial infections which did not lead to treatment failure. Five of the cases of infection were major, one of which was delayed, leading to graft failure. Two patients were lost to follow-up due to unrelated deaths. Eight graft failures occurred, but 65 of 73 patients completely healed giving an overall success rate of 89%. One patient required IntegraTM regrafting once infection of the tibia cleared. Two wounds were allowed to epithelialize without skin grafting.
CONCLUSION: Integra was utilized in a variety of complex non-burn wounds, including chronic wounds, compromised wounds from a history of radiation, and wounds with exposed tendon and bone. The infection rate was high, but can be attributed to the complexity of cases in dealing with colonized wound. In many cases, distal extremity wounds with exposed bone and tendon can be reconstructed, obviating the need for vascularized tissue transfer or microvascular flaps. For chronic wounds, after excision, IntegraTM provides a new matrix for dermal replacement. The overall success of this technique was favorable.