Plastic and reconstructive surgery
Integra™ dermal substitute
Integra™ dermal substitute is a synthetic skin replacement used to reconstruct wounds after elective planned surgery, or after trauma. For patients with extensive skin loss Integra™ dermal substitute acts as a temporary skin substitute. For elective planned surgery: Integra™ dermal substitute produces a better quality skin, with a dermis that has a better plasticity and pliability than would be achieved with a split thickness skin graft alone (which is particularly important around joints). I have also been able to use Integra™ dermal substitute to graft defects that would not normally be suitable for skin grafting, such as the exposed surface of bone on the lower leg or on the scalp.
Composition
Integra™ dermal substitute is a two layered commercial product. The dermal layer consists of a regular matrix of bovine (cow) derived collagen fibres (with a very specific pore size) and chondroitin-6-sulphate. A silicone sheet forms the surface layer, acting as a replacement for the skin’s “barrier function” during the first weeks after grafting with Integra™ dermal substitute.
The grafting of Integra™ dermal substitute
The wound must be clean, with no bacterial colonization, no debris, and no- bleeding. The wound should be relatively shallow, or convex to allow the Integra™ dermal substitute to drape across the wound. The Integra™ dermal substitute is carefully cut to match the shape of the wound. The edge of the wound and the edge of the Integra™ dermal substitute are closely apposed with no significant overlap. I usually use skin staples to attach the Integra™ dermal substitute to the wound edge.
The dressings applied to Integra™ dermal substitute
I apply antibacterial ointment to the skin-Integra™ dermal substitute edge, and then place a layer of a silver impregnated (anti-bacterial) dressing (such as Actocoat™7) on top of the of the Integra™ dermal substitute. A vacuum assisted sponge dressing is then applied (the KCI Vac™ system) to seal the wound and eradicate any potential for disruption of the Integra™ dermal substitute or bacterial invasion of the wound.
Dressing changes
Approximately one week after grafting Integra™ dermal substitute, the dressings are removed and the material redressed without the vacuum assisted sponge dressing.
Skin grafting onto Integra™ dermal substitute neodermis.
Between two and three weeks after grafting Integra™ dermal substitute, a neo-dermis has usually formed. Inflammatory cells from the wound bed migrate into the collagen matrix, and are gradually replaced by connective tissue cells (fibroblasts), and small blood vessels. Once the neodermis is formed, the silicone layer can be peeled away and a very thin meshed split thickness skin graft applied to the wound bed. Most split-skin grafts are between 250 and 375µm, the split skin graft applied to Integra™ dermal substitute can be as thin as 100µm. The donor site for a split skin graft of this thickness will heal within a week. Dressings are applied to the graft and kept in place for about 1 week.
Uses of Integra™ dermal substitute
Grafting of exposed muscle in patients with massive traumatic wounds.
Grafting of wounds with exposed bone, for example after skin cancer excision.
Reconstruction after excision of tight burn-scars.
Reconstruction after excision of self-harm scars.
Reconstruction after excision of scarring around joints.
Integra™ dermal regeneration template: Frequently asked questions
What is Integra™ dermal regeneration template made from?
Integra™ dermal substitute is a two-layered commercial product. The dermal layer consists of a regular matrix of bovine (cow) derived collagen fibres (with a very specific pore-size) and chondroitin-6-sulphate (from shark-fin). A silicone sheet forms the surface layer, acting as a replacement for the skin’s “barrier function” during the first weeks after grafting with Integra™ dermal substitute.
What dressings applied to Integra™ dermal regeneration template?
I apply antibacterial ointment to the skin- Integra™ dermal regeneration template edge, and then place a layer of a silver impregnated dressing (such as Acticoat-7™) on top of the of the Integra™ dermal regeneration template. A vacuum assisted sponge dressing is then applied (the KCI Vac™ system) to seal the wound and eradicate any potential for disruption of the Integra™ dermal regeneration template or bacterial invasion of the wound.
What are the uses of Integra™ dermal regeneration template?
Grafting of exposed muscle in patients with large traumatic wounds.
Grafting of wounds with exposed bone: for example after skin cancer excision.
Reconstruction after excision of tight scars from burns or trauma.
Reconstruction after excision of self-harm scars.
Reconstruction after excision of scarring around joints.
How long have you used Integra™ dermal regeneration template?
I have used this product since 1997. I have used it regularly for the massive lower limb degloving injuries and for elective scar reconstruction.
Where can I find out more about Integra™ dermal regeneration template?
I am happy to send prospective patients copies of relevant publications, there are numerous articles on the web. The distributers website is also helpful:
http://www.integralife.eu/products/plastic/integra-dermal-regeneration-template-2/