Adequate soft-tissue coverage prior to excision of burned tissue is necessary in order to counteract the physiologic, metabolic and psychologic costs associated with burns. Early excision of burned tissue is the key factor in achieving optimal patient outcomes following a burn. Extensive burns often render little tissue available for graft donation, or patient factors may serve as a barrier to skin grafting. Dermal substitutes can act as a scaffold upon which eventual skin grafts can be placed. They serve to improve functional results in the acute phase of thermal injuries, and provide a matrix upon which dermis can be regenerated. Various sources of dermal allograft have been identified.
Skin grafting is a method by which surgeons can soft tissue coverage over burned or badly injured tissue. There are two main categories of grafting: split-thickness or full-thickness. Indications for each graft type vary, and each are dependent on unique variables for healing. While the final cosmetic appearance of full-thickness grafts are often superior, there exists significant donor site morbidity. Split-thickness grafts can often incorporate in tissue where full-thickness grafts would not survive. Regardless of graft type, incorporation of graft is of paramount importance, and depends on multiple factors. As a result, much research has been performed regarding coverage in the setting of skin grafts, and how to optimize chances of graft incorporation, while minimizing patient morbidity.
Skin burns can be catastrophic injuries, and often require multiple debridements and surgeries to achieve eventual skin regeneration. While partial-thickness burns are often managed with local wound care and dressings, full-thickness burns to the dermal layer often require multiple staged-surgeries in order to achieve acceptable soft-tissue coverage.
Burns are broadly classified into four categories: erythema/superficial, superficial-partial thickness, deep-partial thickness and full-thickness. While superficial burns do not often require skin grafting, deep or full-thickness burns too. Skin grafting is not without risk, however, and it is often limited to smaller coverage areas and fraught with morbidity for the patient.
The Integra™ dermal substitute is an advanced, proprietary bilayer matrix which serves as a scaffold for dermal regeneration. It is composed of a mix of bovine cartilage and shark chondroitin. Once covered, re-epithelization can be expected in 2-3 weeks. At this point, half of the bilayer is removed, and a very thin split-thickness graft can be implanted. The immediate availability of the Integra™ product allows for implantation at time of debridement. It is a staged procedure however, and necessitates two trips to the operating room.