ISSN:
1524-475X
Source:
Blackwell Publishing Journal Backfiles 1879-2005
Topics:
Medicine
Notes:
The paradigms of surgical wound closure are direct repair, grafts, and flaps. The core subject of plastic surgery, these distinct modalities are a sophisticated art that can reliably close any healthy wound. The caveat is that ordinary surgery implicitly depends on competent wound healing. With pathological wounds, those due to vascular, hematological, immunopathic, and other ulcerogenic diseases, these modalities may not work. The operation is threatened if wound healing is retarded, and incisions and donor sites are subject to morbidity from active disease. Disease and risks may limit potential donor tissues, sustain inflammation and lysis, restrict circulation, or make the patient too ill for elaborate procedures.Integra® collagen-chondroitin matrix has ideal properties for managing chronic pathological wounds: a high-grade artificial skin; survives disease and conditions where grafts die; performs the coverage duties of flaps without donor sites; minimizes nursing care; suppresses inflammation, wound healing, and scar; induces embryonic dermatogenesis. Risk free to the recipient, it is safe where disease and altered anatomy make conventional closure impossible or unsafe. Its indications, use, results, and conceptual basis make it a distinct fourth paradigm of surgical wound closure: in situ tissue engineering. Understanding when a flap should but cannot be used is to understand when Integra should be used.Study: Using a consistent set of indications and management scheme, Integra was used for chronic pathological wounds in 111 patients (158 individual ulcers, 166 instances of exposed anatomical structures, diverse diagnoses). Success rate was 92% of patients healed; 90% of open structures healed. Inpatient services were nearly eliminated.Integra is not an alternative to conventional repair, grafts, and flaps. As a method of tissue engineering, it is a new and equal paradigm of care with its own indications and contraindications, and a superior safety and success profile. Repair, grafts, and flaps, which require wound healing competency, are best suited for healthy and acute wounds. For many chronic and pathological wounds, in situ matrix-guided histogenesis is the best method, and surgeons must begin working this into their practices.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1111/j.1067-1927.2005.130216ae.x
Permalink