title: Correlation of clinical outcome of integra application with microbiologic and pathological biopsies.
abstract: BACKGROUND
  Integra, a dermal replacement template consisting of bovine collagen, chondroitin-6-sulfate, and a silastic sheet is a postexcisional treatment for deep partial to full thickness burns where autograft is limited. This study correlates Integra histology and quantitative microbiology cultures with clinical outcomes after autografting.
  
  
  METHODS
  Charts of 29 burn patients who underwent Integra treatment and neodermis biopsy at the time of ultra thin autografting were reviewed. We analyzed microbial contamination, inflammatory reaction, and autograft take.
  
  
  RESULTS
  The mean burn size and age were 43% total body surface area and 39 years old, respectively. In quantitative neodermis cultures, 90% of samples had bacterial growth; nine samples (31%) had > 10(5) colony forming units per gram. The most common organism was Staphylococcus aureus (31%). Patients with quantitative bacterial counts >10(5) CFU/g received targeted systemic antibiotics. Integra take (83%) and autograft take (92%) were acceptable even in patients with high bacterial counts (78% Integra take; 86% autograft take). More than 50% of biopsies had dermal regeneration similar to normal dermis; foreign body reactions were unusual. Histologic evidence of inflammation, especially polymorphonuclear cells, was increased in biopsies with high bacterial counts.
  
  
  CONCLUSIONS
  Integra and autograft take can be acceptable even with high bacterial counts if wounds are treated with appropriate targeted topical and systemic antibiotics in the presence of microbial contamination. Neodermis biopsies showed fibrous in-growth congruent with existing Integra fibers with minimal foreign body reaction. These data support Integra use as a safe and effective treatment modality in patients with major burns.
authors.affiliation: University of Washington Burn Center, Department of Surgery, University of Washington, Seattle, Washington 98104, USA.
authors.forename: Pornprom
authors.initials: P
authors.lastname: Muangman
authors.forename: Heike
authors.initials: H
authors.lastname: Deubner
authors.forename: Shari
authors.initials: S
authors.lastname: Honari
authors.forename: David M
authors.initials: DM
authors.lastname: Heimbach
authors.forename: Loren H
authors.initials: LH
authors.lastname: Engrav
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Klein
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Gibran
mesh_terms: D000287:Administration, Topical; D000328:Adult; D001414:Bacitracin / Q000627:therapeutic use; D001672:Biocompatible Materials / Q000627:therapeutic use*; D002056:Burns / Q000628:therapy*; D002809:Chondroitin Sulfates; D003094:Collagen; D015169:Colony Count, Microbial; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D009355:Neomycin / Q000627:therapeutic use; D011112:Polymyxin B / Q000627:therapeutic use; D012189:Retrospective Studies; D016038:Skin Transplantation; D017768:Skin, Artificial / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; D004338:Drug Combinations; C114835:integra artificial skin; D001414:Bacitracin; C001816:bacitracin zinc, neomycin sulfate, polymyxin B, drug combination; D002809:Chondroitin Sulfates; D003094:Collagen; D009355:Neomycin; D011112:Polymyxin B