title: Bioartificial dermal substitute: a preliminary report on its use for the management of complex combat-related soft tissue wounds.
abstract: OBJECTIVE
  To report our institutional experience with the use of a bioartificial dermal substitute (Integra) combined with subatmospheric pressure [vacuum-assisted closure (VAC)] dressings followed by delayed split-thickness skin grafting for management of complex combat-related soft tissue wounds secondary to blast injuries.
  
  
  METHODS
  Retrospective review of patients treated December 2004 through November 2005.
  
  
  METHODS
  Military treatment facility.
  
  
  METHODS
  Integra grafting was performed 18 times in 16 wounds at our institution. Indications for Integra placement were wounds not amenable to simple split-thickness skin grafting, specifically those with substantial exposed bone and/or tendon.
  
  
  METHODS
  Patients underwent an average of 8.5 irrigation and debridement procedures and concurrent VAC dressings prior to placement of the Integra. Following Integra grafting, all patients were managed with VAC dressings, changed every 3 to 4 days at the bedside or in clinic, with subsequent split-thickness skin grafting an average of 19 days later.
  
  
  METHODS
  The mechanism and date of injury, size of residual soft tissue deficit, indication for Integra placement, number of irrigation and debridement procedures prior to Integra placement, days from injury to Integra placement, days from Integra placement to split-thickness skin grafting, and clinical outcome were recorded.
  
  
  RESULTS
  Integra placement and subsequent skin grafting was successful in achieving durable and cosmetic definitive coverage in 15 of 16 wounds with two of these patients requiring repeat Integra application. Two patients with difficult VAC dressing placement had early Integra graft failure but successfully healed following repeated Integra application and skin grafting.
  
  
  CONCLUSIONS
  Bioartificial dermal substitute grafting, when coupled with subatmospheric dressing management and delayed split-thickness skin grafting, is an effective technique for managing complex combat-related soft tissue wounds with exposed tendon. This can potentially lessen the need for local rotational or free flap coverage.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, Washington, DC 20307, USA.
authors.forename: Melvin D
authors.initials: MD
authors.lastname: Helgeson
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Potter
authors.forename: Korboi N
authors.initials: KN
authors.lastname: Evans
authors.forename: Scott B
authors.initials: SB
authors.lastname: Shawen
mesh_terms: D002809:Chondroitin Sulfates; D003094:Collagen; D003646:Debridement; D020405:Dermis / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D006801:Humans; D016038:Skin Transplantation; D017768:Skin, Artificial; D017695:Soft Tissue Injuries / Q000601:surgery*; D016896:Treatment Outcome; D014618:Vacuum; D014857:Warfare; D014945:Wound Healing; D014950:Wounds, Penetrating / Q000473:pathology / Q000601:surgery*
chemical_list: C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen