Purpose: The synthetic dermal regeneration template Integra® (Integra Life Sciences, Inc., Plainsboro, N.J.) is currently used in a two-stage procedure that allows 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 cost and morbidity to the patient. Using sub-atmospheric pressure treatment (V.A.C., K.C.I., Inc., San Antonio, TX) as a dressing for Integra has previously allowed one-stage engraftment of Integra in an animal model. We now report our initial experience with one-stage Integra use in a clinical series.

Methods: Patients were chosen for this technique when skin graft alone was not deemed suitable as a reconstructive option. Each patient underwent the usual surgical wound care used for a two-stage approach. The Integra was meshed 1:1 and the silicone layer was separated from the dermal matrix portion. The dermal matrix was placed in the wound and covered with a thin split-thickness skin graft and a non-adherent dressing. A subatmospheric pressure dressing was then applied and left in place for a period of at least 7 days.

Results: Fifteen patients (Age 36-76) were evaluated. The wound size was 4 – 250 cm2 (mean = 79 cm2). Etiology of wound was release of burn scar contractures in two, chemical injury in one, trauma defects in 4, and cancer resection in one. Exposed in the wound was tendon (n= 4), bone (n = 4,), open fracture (n = 2) and two with soft tissue alone. Healing was complete in 7 cases without the need for re-operation. In one, the Integra and skin graft was lost associated with an interruption of the subatmospheric pressure dressing.

Conclusions: Using subatmospheric pressure dressings, Integra may be successfully used for one-stage coverage for burn reconstruction and other challenging wounds.