title: The positive effect of negative pressure: vacuum-assisted fixation of Integra artificial skin for reconstructive surgery.
abstract: BACKGROUND
  Integra artificial skin (Integra) (Integra Life Sciences Corporation, Plainsboro, NJ) is increasingly used as a skin substitute in reconstructive surgery. However, reliable fixation to the wound bed, a factor of paramount importance for successful application, is often hard to achieve. The vacuum-assisted closure system (VAC; KCI, Switzerland), a well-established subatmospheric pressure device, might be of interest to overcome these problems because of its ability to conform to almost any surface. The goal of this study was to test whether negative pressure application yields reliable fixation of Integra in children undergoing reconstructive surgery.
  
  
  METHODS
  Between 2001 and 2004, VAC was applied in 18 children (n = 18) aged 7 months to 16.5 years. All required reconstructive surgery with implantation of Integra covering 1% to 12% of the total body surface area. After Integra implantation, VAC was installed for 13 to 30 days.
  
  
  RESULTS
  The VAC fixation of Integra was successful in 17 patients (94.5%). The only failure (5.5%) occurred in a patient in whom negative pressure could not be maintained because of a lesion site susceptible to both dislodgement and infection (perianal region). Consequently, infection occurred, and Integra had to be removed.
  
  
  CONCLUSIONS
  These results demonstrate that VAC is a valid tool for reliable fixation of Integra in children undergoing even demanding reconstructive surgery.
authors.affiliation: Pediatric Burn Center, Plastic and Reconstructive Surgery, Department of Surgery, University Children's Hospital Zurich, CH-8032 Zurich, Switzerland.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Stiefel
authors.forename: Clemens M
authors.initials: CM
authors.lastname: Schiestl
authors.forename: Martin
authors.initials: M
authors.lastname: Meuli
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D017439:Cicatrix, Hypertrophic / Q000601:surgery*; D003094:Collagen / Q000627:therapeutic use*; D005260:Female; D006222:Hamartoma / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D054843:Negative-Pressure Wound Therapy; D009508:Nevus, Pigmented / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012878:Skin Neoplasms / Q000601:surgery*; D017768:Skin, Artificial
chemical_list: C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen