Purpose: The synthetic dermal regeneration template, Integra (Integra Life Sciences, Inc., Nutley, N.J.) is currently used in a two-stage procedure to allow vascularization of the matrix prior to placing a skin graft. If this could be performed as a one-stage procedure, it would result in less surgery for patients, a significant cost savings, and ultimately less morbidity to the patient. Sub-atmospheric pressure treatment (V.A.C., K.C.I., Inc., San Antonio, TX) has improved blood flow to wounds, accelerated Integra incorporation in complex tissue defects, and is a dressing used for skin graft procedures. We hypothesized that applying this device to the dermal matrix with immediate skin grafting should allow one-stage vascularization.
Materials and Methods: Three pairs of full-thickness wounds were created on the dorsum of six pigs. Wounds were covered with (A) split thickness skin graft (STSG) alone, (B) Integra dermal regeneration template (without silicone) plus STSG, or (C) Integra matrix wound dressing plus STSG. The Integra and skin graft were meshed 1:1 and treated with subatmospheric pressure. Dressing changes were performed at 7, 10, and 14 days. At these intervals, tissue biopsies were obtained. Percent engraftment was determined by digital planimetry and blood flow was assessed using scanning laser doppler.
Results: The subatmospheric pressure treatment of Integra with immediate skin grafting resulted in comparable engraftment to the control group. Percent engraftment for both the Integra dermal regeneration template (85.38% +/- 9.88) and matrix wound dressing (75.69% +/- 24.22) yielded results equal to skin grafting alone (83.52% +/- 26.11). These values were not significantly different from the control group (p=0.95 for Integra and p=0.45 for the matrix wound dressing). Blood flow was significantly greater in the wounds covered with Integra compared to the control group (p<0.02).
Conclusions: Single-stage application of a split thickness skin graft over a dermal regeneration template has engraftment rates similar to skin graft controls in this animal model. This study provides the basis for clinical evaluation of the one-step procedure in the treatment of full-thickness wounds.
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