Single-layer Integra for one-stage reconstruction of scalp defects with exposed bone following full-thickness burn injury: A novel technique

Kosutic, Damir; Beasung, Eamon; Dempsey, Marlese; Ryan, Louise; Fauzi, Ziham; O'Sullyvan, Barry; Orr, David

doi:10.1016/j.burns.2011.08.019

Cited by 27 publications

(24 citation statements)

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“…11,21,27,39–41 Five of the 6 studies did not apply a skin graft, 11,21,39–41 while one applied both Integra and skin graft in the same procedure. 27 One case report performed one-stage reconstruction of a defect ≥100 cm 2 , reporting a minor infection in the postoperative period. 11 Percent take for one-stage studies was 100%.…”

Section: Resultsmentioning

confidence: 99%

“…Burring was employed in 74.2% of the studies included in this systematic review, with percent take ranging from 50% to 100% (Table 4). 10,12,14,15,17–20,22–24,27,28,30–34,36–38,40 Percent take was >90% in studies not employing bone burring. 9,11,12,16,17,29,35,39,41 …”

Section: Resultsmentioning

confidence: 99%

“…The remaining 22 articles using unfenestrated Integra reported percent take ranging from 50% to 100%. 9–11,14–16,18–20,22–25,27,31–35,37,39,42 Fung et al 37 reported hematoma formation under unfenestrated Integra resulting in 90% graft take.…”

Section: Resultsmentioning

confidence: 99%

“…VAC was the most common postoperative wound dressing (32%). 19,22,24,27,28,33,35,38 These studies reported percent take of 50–100%, with 87.5% of studies reporting percent take >98%. Bolstered dressings (28%) and silver-impregnated dressing materials (24%) were also popular, with percent take ≥90% in all cases.…”

Section: Resultsmentioning

confidence: 99%

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Integra-based Reconstruction of Large Scalp Wounds: A Case Report and Systematic Review of the Literature

Johnson

Wong

2016

Plastic and Reconstructive Surgery - Global Open

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Background:Large complex scalp wounds that have traditionally required free vascularized tissue transfer have been successfully reconstructed with skin substitutes such as Integra. Although there are multiple reports of Integra-based reconstructions of scalp wounds, there has not been a comprehensive assessment of this body of literature that critically examines this method. Our goal was to conduct a systematic review to determine the effectiveness of Integra-based reconstructions of scalp wounds, with emphasis on large defects.Methods:A comprehensive systematic review was completed using key search terms, including Integra, dermal regeneration template, bovine collagen, skin substitute, forehead, and scalp. Selected articles reported characteristics of patients and their reconstructions. The primary outcome measures were wound complications and percent graft take.Results:Thirty-four articles were included in this systematic review. Wound sizes ranged from 5.7 to 610 cm2, with 35.3% of articles reporting a mean defect size >100 cm2. Thirty-two articles reported mean percent take of skin graft ≥90%. Sixteen articles reported a minor complication. There were no major complications associated with the reconstructions.Conclusions:There is a substantial evidence base for the use of Integra to reconstruct scalp wounds. To date, the dermal regeneration template is generally reserved for salvage procedures or when the patient cannot tolerate free tissue transfer. Based on the findings of this systematic review and the authors’ clinical experience, Integra can be used to achieve predictable results in large complex scalp defects.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Integra-based Reconstruction of Large Scalp Wounds: A Case Report and Systematic Review of the Literature

Johnson

Wong

2016

Plastic and Reconstructive Surgery - Global Open

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“…Biological dressings can be synthetic, xenograft (ie porcine skin), autograft (ie human amnion) or allograft (eg cadaveric skin). Dermal substitutes such as Integra ® (Integra LifeSciences, Plainsboro, NJ, US) have also revolutionised wound care 3 and would probably have been our second-line treatment for our patient if he had succumbed to wound infection and the necrotic flap had required debridement before the underlying wound bed was graftable. A comparable form of our type of wound salvage has been described once previously when failed lower limb free flaps were used as a temporary biological dressings in a similar way.…”

Section: Discussionmentioning

confidence: 99%

The use of a failed flap as a biological dressing

Chadwick

Kosutic

2016

annals

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A patient with a narrowly excised squamous cell carcinoma on the scalp underwent a wider excision that involved burring of the underlying calvarium. The defect was reconstructed with a superficial temporal artery pedicled flap, which unfortunately failed. The patient had multiple co-morbidities, limiting reconstructive options. The failed flap was therefore maintained as a 'biological dressing' for several weeks. During this time, the patient was reviewed regularly in the dressing clinic and did not develop a wound infection. Six weeks later, he was taken back to theatre and the flap was debrided under local anaesthesia. Beneath the flap, there was sufficient healthy granulation tissue over the site of previous bony debridement to permit split skin grafting. We advocate this technique as a useful method for managing difficult wounds in complex patients with multiple co-morbidities where other reconstructive techniques are limited. KEYWORDSWound healing -Flap -Skin cancer Cutaneous scalp malignancies are a common problem and seem destined to increase in prevalence with our ever ageing population, particularly among Fitzpatrick skin types I and II. Over 100,000 cases of non-melanoma skin cancer (NMSC) were registered in the UK in 2011, with around 640 deaths in 2012.1 These lesions are encountered regularly by plastic surgeons as they often require a resection that cannot be closed primarily and need formal reconstruction with skin grafting or flap cover. In the case of invasive cancers on the scalp, a common site for NMSC, burring of the underlying calvarium may be required, leaving a defect that cannot be managed with skin grafting and that requires more robust flap reconstruction. To further complicate these cases, patients presenting with such lesions often have other co-morbidities, making them high risk for general anaesthesia, and complex free flap reconstructions are often not viable options for this group. Multiple co-morbidities can also lead to problems with wound healing and failure of the reconstruction, leaving the patient with a complex, unhealed wound that requires further intervention. We present a case in which a novel and previously undescribed 'salvage' procedure was undertaken to turn a failed flap into a graftable wound bed. Case historyOur patient was an 80-year-old man who had previously had a poorly differentiated squamous cell carcinoma excised from his frontal scalp. The resulting defect was reconstructed with a split-thickness skin graft but histological analysis of the specimen revealed a close deep margin and further deeper excision was recommended by the multidisciplinary team. He had multiple co-morbidities including coronary artery disease, atrial fibrillation and chronic obstructive pulmonary disease, and he was on multiple medications including warfarin.The patient underwent a wider and deeper excision of the lesion with burring of the underlying calvarium, and the new defect was reconstructed with a fasciocutaneous superficial temporal artery pedicled flap (Fig 1). Altho...

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The progress and challenges for dermal regeneration in tissue engineering

Zhou

You

Wang

et al. 2017

J Biomedical Materials Res

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Wound healing is an inherent response resulting in the restoration of tissue integrity. It is a complex process involving cell migration, proliferation, differentiation, apoptosis, and the synthesis and remodeling of the extracellular matrix (ECM). The dermal tissue is an important component of skin that acts as a connecting link between the epidermis and hypodermis. The appearance of scars and contractures after autologous split-thickness skin transplantation or single epidermis diaphragm transplantation for full skin defects indicates that the dermal tissue plays an important role in skin regeneration. Theoretically, dermis cannot regenerate like the liver, bone and epidermis after being destroyed by burns or avulsion. Scarring is hard to avoid during the process of natural healing. However, if the dermis could be reconstructed perfectly, this would be a breakthrough in the methods used for wound healing. In this review, we summarize recent research about dermal regeneration and discuss the probability of advances in the field. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 1208-1218, 2017.

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Single-layer Integra for one-stage reconstruction of scalp defects with exposed bone following full-thickness burn injury: A novel technique

Cited by 27 publications

References 1 publication

Integra-based Reconstruction of Large Scalp Wounds: A Case Report and Systematic Review of the Literature

Integra-based Reconstruction of Large Scalp Wounds: A Case Report and Systematic Review of the Literature

The use of a failed flap as a biological dressing

The progress and challenges for dermal regeneration in tissue engineering

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