Coverage of Deep Cutaneous Wounds Using Dermal Template in Combination with Negative-pressure Therapy and Subsequent Skin Graft

Abstract

Background:We consider the use of dermal matrix associated with a skin graft to cover deep wounds in the extremities when tendon and bone are exposed. The objective of this article was to evaluate the efficacy of covering acute deep wounds through the use of a dermal regeneration template (Integra) associated with vacuum therapy and subsequent skin grafting.Methods:Twenty patients were evaluated prospectively. All of them had acute (up to 3 weeks) deep wounds in the limbs. We consider a deep wound to be that with exposure of bone, tendon, or joint.Results:The average area of integration of the dermal regeneration template was 86.5%. There was complete integration of the skin graft over the dermal matrix in 14 patients (70%), partial integration in 5 patients (25%), and total loss in 1 case (5%). The wound has completely closed in 95% of patients.Conclusions:The use of Integra dermal template associated with negative-pressure therapy and skin grafting showed an adequate rate of resolution of deep wounds with low morbidity.

Negative pressure wound therapy as a definitive treatment for upper extremity wound defects: A systematic review

“…An in vitro model by Baldwin et al showed that negative pressure managed to switch endothelial cells, which normally fail to fully penetrate Integra, to a migratory and proliferative phenotype and demonstrated that intermittent negative pressure allowed greatest ingress . Other groups showed significantly increased take rate and integration, reduced hospital stay, improved clinical outcomes, and reduced complication rates when NPWT was applied to Integra . Although cases of hand and upper extremity reconstructions are included in these studies, very few authors have limited their analysis to that anatomical region.…”

Management of skin defect following resection of Stage IV scalp melanoma: A case report

“…Furthermore, it has been shown that during the third week after application, blood vessel lumen develops in the template [6]. Studies have also shown a positive association between dermal regeneration templates and negative-pressure therapy by promoting faster integration of the matrix and fewer complications such as infection [7]. This suggests that a combination of INTEGRA ® , negative pressure dressing, and skin graft may favor faster maturation of the dermal template and increase the chance of the graft taking well.…”

Reconstruction of Full-thickness Soft Tissue Defects with Integra: Risk Factors and Treatment Algorithm

“…Several studies have revealed the efficacy of dermal substitutes in reconstructing posttraumatic or post oncological defects, and such techniques now represent a tissue-engineered alternative to flap surgery, especially in medically compromised individuals because they reduce surgical morbidity. 1 , 2 Moreover, dermal substitutes have been investigated even from a functional perspective, and several reports have shown that they might represent a safe and reliable tool for the reconstruction of challenging areas such as joints or weight-bearing surfaces. 3 – 5 …”