Reconstructive surgery with a dermal regeneration template: Clinical and histologic study

Integra artificial skin was introduced in 1981 and its use in acute surgica l management of burns is well established, but Integra has also been used i n patients undergoing reconstructive surgery. Over a period of 25 months, t he authors used Integra to cover 30 anatomic sites in 20 consecutive patien ts requiring reconstructive surgery and then analyzed the clinical and hist ologic outcomes. The most common reason for surgery was release of contract ure followed by resurfacing of tight or painful scars. The authors assessed patients' satisfaction using a visual analog scale and scar appearance usi ng a modified Vancouver Burn Index Scale. They evaluated the progress of wo und healing by examining weekly punch-biopsy specimens with standard and im munohistochemical stains. Patients reported a 72 percent increase in range of movement, a 62 percent improvement in softness, and a 59 percent improve ment in appearance compared with their preoperative states. Pruritus and dr yness were the main complaints, and neither was improved much. Four distinc t phases of dermal regeneration could be demonstrated histologically: imbib ition, fibroblast migration, neovascularization, and remodeling and maturat ion. Full vascularization of the neodermis occurred at 4 weeks. The color o f the wound reflected the state of neodermal vascularization. No adnexa, ne rve endings, or elastic fibers were seen in any of the specimens. The new c ollagen was histologically indistinguishable from normal dermal collagen. T he authors conclude that Integra is a useful tool in reconstructive surgery . The additional cost of its use can be justified by its distinct benefits compared with current methodology.