Integra as a Dermal Replacement in a Meshed Composite Skin Graft in a Rat Model: A One-Step Operative Procedure.

摘要

Background: Current use of Integra, the collagen-based dermal analogue, requires a two-step grafting procedure to achieve wound closure with an ultrathin autograft. Methods: A one-step operative procedure of meshed composite skin graft (MCSG) using Integra as a dermal template for a meshed split thickness autograft was developed in rats. The silicon layer of Integra was removed, the resulting dermal analogue was meshed (1:1.5), expanded, and placed on excised full thickness wound and covered with a meshed (1:1.5 or 1:6) split thickness autograft. Grafted wounds were dressed with BioBrane, Vaseline gauze, silver-impregnated nylon, or silver-nylon and direct current (SNDC). At scheduled intervals up to 3 months postgrafting, wounds were examined for epithelialization, collagen deposition and fibrosis, hair growth, and contraction. The results of wound clo- sure and healing following the one-step procedure were compared with the out- come of the two-step grafting procedure where application of meshed Integra (step one) was followed in 14 days by removal of the silicon layer and application of the meshed autograft (step two). Results: The one-step procedure applied to meshed autograft/Integra (1:1.5/ 1:1.5) composite graft accelerated wound closure by 6-19 days when compared with the two-step procedure. At 3 months post- grafting, the contraction of the healed wound dressed with SNDC, BioBrane, or Vaseline gauze was reduced by 13-16% following the one-step procedure compared with the two-step procedure ( p less than 0.05). The one-step procedure allowed the expansion of the autograft layer to 1:6 while achieving wound healing results similar to grafting with 1:1.5 meshed autograft layer using the two-step grafting procedure.