Integra® Meshed Dermal Regeneration Template
Integra® Meshed Dermal Regeneration Template is an advanced bilayer matrix consisting of a porous, three-dimensional dermal replacement layer and a temporary epidermal layer. The dermal replacement layer (collagen and glycosaminoglycan) is designed with a controlled porosity and defined degradation rate to promote neodermal formation. The epidermal layer (pre-meshed polysiloxane) provides a moisture and bacterial barrier.
• FDA-approved for partial- and full-thickness third-degree burns and reconstruction of scar contracture
• Biodegrades while being replaced autologous tissue
• Promotes cellular growth and collagen synthesis
• Pre-meshed configuration saves time in the OR
• Consistent meshed design allows better conformity to the wound bed and ease of handling
Integra® Meshed Dermal Regeneration Template is indicated for the post-excisional treatment of life-threatening full-thickness or deep partial-thickness thermal injuries where sufficient autograft is not available at the time of excision or not desirable due to the physiological condition of the patient. Integra template is also indicated for the repair of scar contractures when other therapies have failed or when donor sites for repair are not sufficient or desirable due to the physiological condition of the patient.
Contraindicated in patients with known hypersensitivity to bovine collagen or chondroitin materials. Integra® template should not be used on clinically diagnosed infected wounds.
Excision of the wound must be performed thoroughly to remove all coagulation eschar and nonviable tissue. Integra® template will not "take" (incorporation into the wound bed) to nonviable tissue. Leaving any remaining nonviable tissue may create an environment for bacterial growth. Hemostasis must be achieved prior to applying Integra® template. Inadequate control of bleeding will interfere with the incorporation of Integra® template.
There have been no clinical studies evaluating Integra® template in pregnant women. Caution should be exercised before using Integra® template in pregnant women. Such use should occur only when the anticipated benefit clearly outweighs the risk. In clinical trials, the use of Integra® template was evaluated in a small number of patients with chemical, radiation, or electrical burns. A surgeon’s decision to use Integra® template on these wounds should be based on their evaluation of the wound and its suitability for excisional therapy, the likelihood that a viable wound bed will be created by excision, and whether the possible benefit outweighs the risk in this patient population.
Integra® template should be applied on the day of excision. Delaying the application of Integra® template may substantially impair the take of the material.
Appropriate techniques to minimize pressure and shearing should be used to reduce risk of mechanical dislodgement.
Placing the patient in hydrotherapy immersion may interfere with proper incorporation of the Integra® template and cause premature separation of the silicone layer and nonadherence of the template. Caution must be employed to not remove the newly formed neodermal tissue when removing the silicone layer. Integra® template must NOT be excised off the wound.
Integra® template has been found to be well tolerated in four prospective clinical trials involving 444 burn patients. There were no reports of clinically significant immunological or histological responses to the implantation of Integra® template. There were no reports of rejection of Integra® template.
Adverse events in the Postapproval study were similar to those observed in the previous clinical trials and are common in populations of critically ill burn patients regardless of type of treatment used. There were no trends noted. There were six adverse events which were rated by the investigator as being related. These events were all single occurrences except for sepsis (2). These adverse events occurred in less than 1% of the safety population.
For full list of list of Adverse Events, please see Integra® Dermal Regeneration Template Instructions for Use.
Store flat at 2°C-30°C. Protect from freezing.
|Indicated for chronic vascular ulcers|
|Indicated for diabetic ulcers|
|Indicated for draining wounds|
|Indicated for partial- and full-thickness wounds|
|Indicated for pressure ulcers|
|Indicated for surgical wounds|
|Indicated for third-degree burns||●|
|Indicated for trauma wounds|
|Indicated for venous ulcers|
|Variety of sizes||●|
|Educational Material Available||●|
|Free Samples/Trials Available||●|
|Published Clinical Article Available|
Always handle Integra® template using aseptic technique. Peel open the outer pouch and remove the inner foil pouch using sterile technique. Place foil pouch flat on a sterile surface and peel it open. Remove product, including the protective polyethylene cover sheets. While holding the product with the tab, remove one polyethylene cover sheet. Turn the product and remove the second polyethylene cover sheet. Using the tab, the product can now be placed into a basin containing sterile saline solution. Carefully remove the tab from the product. Rinse the product by immersion in sterile saline for 1–2 minutes. Keep product in the basin until application.
Excision must be made to the level of viable tissue and meticulous hemostasis must be achieved before application of Integra® template. Excisional techniques for Integra® template sites can be fascial, sequential, or tangential. It is absolutely critical to the successful take of Integra® template that excision be complete and that no devitalized tissue remains. Complete hemostasis must be achieved before application of Integra® template. The presence of hematoma will cause loss of Integra® template in the affected area. Broad area cauterization that could decrease wound bed viability should be avoided.
Shaping Integra® Template to Fit the Wound
Integra® template should be shaped accurately to fit the excised wound margins to minimize scarring at these margins. It should not be overlapped onto non-excised areas or onto other sheets of Integra® template. It is easily cut with sterile scissors by placing the sheet of Integra® template over the excised wound bed and cutting exactly to the edge.
Applying Integra® Template to the Wound
It is critical that the collagen template layer be in direct contact with the excised wound. The silicone layer (identified by the black threads) must be placed out (away from the wound bed). Do not apply upside down, the black threads must be clearly visible. For optimal cosmetic results, place the Integra® template so that the suture lines between Integra® template sheets lie in Langer’s lines. This will minimize the final appearance of the suture lines.
The Integra® template sheets are secured by staples or sutures placed in an interrupted fashion under slight tension. If the Integra® template has been meshed, care must be taken not to spread the mesh. Care should be taken to achieve a primary closure between Integra® template and adjacent unburned skin or between sheets of Integra® template. Suture or staple each sheet of Integra® template in place independently. The Integra® template sheets may also be affixed to one another to assure that there is no gap between sheets. Adjust the area to ensure that there is no undue tension on an individual piece of Integra® template. The material should readily adhere and conform to the wound surface. Any air bubbles should be carefully removed by moving them to the edge of the sheet. Dressings should be applied over Integra® template according to the protocol of the practitioner.
The inner dressing need not be disturbed unless there are problems requiring intervention. The attachment of the silicone layer should be examined. An antibacterial dressing may be used or the outer dressing can be soaked in an appropriate antimicrobial solution.
There should be no hydrotherapy immersion of the patient following Integra® template application while the silicone layer is in place. Mechanical dislodgment of Integra® template should be avoided. Ambulation and physical therapy can be instituted according to the condition of the patient and judgment of the practitioner. All Integra® template sites must be securely covered with dressings before ambulation and/or physical therapy.
Staples or sutures should remain in place until the time of epidermal autografting. The staples or sutures help secure the silicone layer and decrease the likelihood of premature silicone layer separation.
The silicone layer of Integra® template may be removed when the collagen layer has been replaced by neodermis, usually 14 to 21 days after application. Removal of the silicone layer and grafting may take place immediately after formation of the neodermis, if epidermal autograft is available. The removal of the silicone layer may be postponed until donor sites for epidermal autograft area are available.
The clinician must be careful when removing the silicone layer. The silicone layer can usually be removed using only forceps. Generally, it should peel off easily. Difficulties in removal may indicate that neodermis formation is incomplete. However, if the silicone is difficult to remove, a forceps and scalpel may be used to gently separate the silicone layer from the neodermis. Caution must be employed to not remove the newly formed neodermal tissue when removing the silicone layer. Integra® template must not be excised off the wound.
Harvesting and Preparation of the Epidermal Autograft
Epidermal autograft can be taken from sites unsuitable for conventional autograft, for example small areas from which a large intact sheet would be impossible. If possible, the area should be matched for color and type of skin.
A thin epidermal autograft should be taken at a thickness just sufficient to provide punctate bleeding of the donor site, typically 0.004-0.006" (0.10mm-0.14mm). Dermal tissue is not needed in the epidermal autograft and should be minimized.
Typically, the thin epidermal autograft may be meshed up to a 4:1 ratio. The meshed epidermal
autograft may be fragile and care should be taken in handling the graft.
Application of the Epidermal Autograft to the Neodermis
The epidermal autograft should be placed over the neodermis by spreading the meshed autograft. It should be spread as evenly as possible over the neodermis without leaving large open areas.
Completion of the epidermal autograft procedure should follow the standard protocol for full sheet or meshed autograft. The epidermal autograft should be anchored by sutures or staples. The dressing over the epidermal autograft should be similar to that used over conventional meshed autograft.
Integra LifeSciences, a worldwide leader in regenerative medicine, is dedicated to improving the quality of life for patients through the development of cost-effective solutions used to treat millions of patients every year. With over two decades of clinical efficacy and a reputation for delivering quality, Integra's advanced wound care products are a premiere solution for clinicians.