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

Abstract

Background: Despite the fact that dermal substitutes are widely used in reconstructive surgery, there have been no studies focused on predictors of complications or delayed matrix take. We propose an algorithm for management of soft tissue reconstruction with Integra dermal matrix, based on our 5-year-long clinical experience. Methods: An estimated 111 patients who underwent Integra reconstruction of full-thickness soft tissue defects of different anatomical sites and etiology were enrolled, and dichotomized in two groups according to complications. Participants were further studied according to the wound healing strategy: healing by secondary intention, skin graft (STSG), and flap surgery. A regression analysis was conducted in the whole sample to identify possible predictors of complications. Results: No significant differences according to complications were observed. The between-group statistical analysis showed significant differences in age, comorbidities, defect area, diagnosis, and defect site. The regression analysis revealed that the timing of split-thickness skin graft (STSG) was not influenced by age, comorbidities, body mass index (BMI), defect area, site, wound etiology, and risk factors in the subjects who underwent a two-step reconstruction. Healing by secondary intention is recommended for small post-oncological defects of the head, especially in elderly and multimorbid patients. Variables that may interfere with dermal substitutes’ incorporation are independent of the timing of STSG placement; therefore, no predictors of complications or delayed matrix take were identified. Conclusions: Our findings showed that Integra can be used in a wide range of patients regardless of their general features, thus acting as a useful alternative to conventional reconstructive techniques in selected cases.

Advancements in Skin Grafting: Development and Applications of a Novel Multi-Blade Dermatome for Concurrent Split-Thickness and Dermal Graft Harvesting A technical note and proof of principle

“…These mentioned grafts are thicker than the thickness to the dermal graft [16]. The dermal graft can on the other hand be used without supplementary templates which may be an advantage [17].…”

Vascular persistence following precision micropuncture

“…The combination of MP in these scenarios could lead to a rapidly perfused and stably vascularized tissue-engineered construct with the potential to mitigate necrosis of any embedded cells from the onset. Also, as Type 1 collagen scaffolds are widely used in clinical reconstructive surgery [57][58][59] our surgical approach could be modified to provide a stable source of vascularization in a high-demand area, such as a radiated wound bed.…”

Role of microsurgical free flap reconstruction in managing complex wound: a retrospective cross-sectional study

“…occurring in (50%) of patients, followed by blast injuries in 33% of cases, gunshot wounds in 10%, and crush injury in 10% of cases [ 15 ]. A recent study in Italy showed that tumor-associated defects were the most common cause (65.8%) preceding trauma (13.5%) [ 19 ]. The heterogeneity of the mechanism of the defect in various studies is attributed to the different geographical and demographic nature of the populations.…”