Purpose: Integra® (Integra Life Sciences, Inc., Nutley, NJ) is a bilaminate skin substitute used for acute burn and reconstructive surgery which is covered with a thin skin graft after engraftment of the dermal matrix. The application of Integra using subatmospheric pressure (V.A.C.®, K.C.I. Inc., San Antonio, TX) is easier, faster, and more consistent than other dressings but remains costly. We evaluated the feasibility of using subatmospheric pressure treatment of Integra on an outpatient basis as a method of cost containment.
Methods and Materials: Seven patients were chosen for outpatient reconstructive surgery with Integra and subatmospheric pressure. Four patients were burn reconstruction (axillary and antecubital fossa contracture release), one patient was for scalp keloid reconstruction, and two patients were for reconstruction of traumatic foot/ankle wounds. After wound preparation and Integra application in the operating room, the V.A.C. was applied as the dressing. The patients were admitted for overnight stay in our outpatient hospital for pain management and verification of V.A.C. function. Patients were discharged on postoperative day one with home V.A.C (one patient was discharged immediately postoperatively). Some patients were seen in the clinic in 3 – 5 days for a wound check but others were managed entirely at home. Patients returned to the operating room in 7 – 9 days for V.A.C. removal and split thickness skin graft. The V.A.C. was again applied as post-graft dressing and patient was discharged on an outpatient basis (one patient stayed overnight) before returning in 4 days for V.A.C. removal in the clinic.
Results: All patients were successfully reconstructed with near complete take of Integra at the time of grafting and 70-100% take of split thickness skin grafts; mean 88%. No patients required additional grafting.
Conclusion: Integra may be successfully used for reconstruction of difficult areas as an outpatient in combination with subatmospheric pressure. This allows for successful reconstruction and expedited treatment versus standard Integra application, and decreased morbidity and costs. Further prospective studies are required to demonstrate the uses and limitations of this technique.
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