title: Long-term clinical and histological analysis of Integra dermal regeneration template.
abstract: BACKGROUND
  This study looked at clinical and histological outcomes of patients treated with Integra more than 2 years earlier. Although previous studies have investigated the short-term clinical and histological results, there have been no studies to investigate longer-term changes.
  
  
  METHODS
  Fourteen patients (23 sites) were assessed. Patients used a visual analogue scale to score characteristics of their scars. Objective evaluation of the reconstructions was carried out using the Cutometer MPA580. Punch biopsy specimens of the sites were stained and labeled immunohistochemically with S100, CD31, and CD34 antisera.
  
  
  RESULTS
  The highest scoring category by patients was softness (median, +45 percent). The lowest score was sweating, which all patients scored 0. The median Cutometer readings ranged from 39 to 52 percent of the control values. Histological examination showed three patterns of collagen arrangement; parallel arrangement was found in over 60 percent of specimens. Elastic fibers were identified in all specimens; however, all were of abnormal morphology. The majority of specimens showed evidence of nerve fiber regeneration although confined to the mid- or lower reticular dermis. There was no regeneration of skin adnexa.
  
  
  CONCLUSIONS
  This study showed significant improvements in patient-assessed mobility, softness, and appearance. Collagen and elastic fibrin were present in all specimens, nerve fiber regeneration was limited to the mid- or lower reticular dermis, and adnexal structures were absent. The typical wrinkled appearance of mature Integra reconstruction cannot be said to be entirely due to a lack of elastic fibers.
authors.affiliation: Birmingham and Wolverhampton, United Kingdom From the University Hospital Birmingham National Health Service Foundation Trust and Royal Wolverhampton Hospitals National Health Service Trust.
authors.forename: Naiem
authors.initials: N
authors.lastname: Moiemen
authors.forename: Jeremy
authors.initials: J
authors.lastname: Yarrow
authors.forename: Elaine
authors.initials: E
authors.lastname: Hodgson
authors.forename: Jiannis
authors.initials: J
authors.lastname: Constantinides
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chipp
authors.forename: H
authors.initials: H
authors.lastname: Oakley
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shale
authors.forename: Martin
authors.initials: M
authors.lastname: Freeth
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002809:Chondroitin Sulfates; D002921:Cicatrix / Q000473:pathology / Q000601:surgery*; D003094:Collagen; D020405:Dermis; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D015595:Skin Aging; D016038:Skin Transplantation / Q000379:methods*; D017768:Skin, Artificial; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult
chemical_list: C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen