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      Uso del regenerador dérmico Integra® como material de relleno para el tratamiento de defectos del contorno corporal Translated title: Use of Integra® dermal regeneration template in deep tissue planes for contour defects treatment

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          Abstract

          En el tratamiento de los defectos de contorno corporal se usan múltiples productos biológicos y/o sintéticos. Cuando el volumen no es grande, los autores plantean el uso del regenerador dérmico Integra® eliminando previamente su capa superficial de silicona frente a los inconvenientes que presenta el uso de otros materiales de relleno en Cirugía Plástica (reabsorción variable, intolerancia, infección, granulomas, calcificación, etc). Dicho producto acaba transformándose en neodermis del propio paciente, bien tolerada. Presentamos dos casos con defectos a nivel frontal (postraumático) y en tórax anterior (secuelas de reconstrucción tras mastectomía) respectivamente, en los que se colocó Integra® en bolsillos profundos y doblado sobre sí mismo para aumentar su volumen. Los resultados son previsibles, con mínima reabsorción y además son duraderos, con seguimiento a los 6 y 12 meses. Los autores recomiendan el uso del regenerador dérmico en volúmenes moderados y/o pequeños, considerando que en grandes volúmenes es preferible el uso del colgajos autólogos y/o colgajos más prótesis.

          Translated abstract

          In the treatment of body contour defects we can use many biological and synthetic products. They have many inconvenient effects as variable reabsortion, intolerance, infection, granulomas, calcification, etc. In moderate defects, the authors propose the use of modificated Integra® dermal regeneration template without the superficial silicone layer. Two patients are reported, one with a traumatic frontal defect and another with a depression in the anterior thorax after postmastectomy breast reconstruction post mastectomy. In both we put Integra® into a subcutaneous pocket and we bent it to increase lamina volume. Results are predictable, permanent, with minimal reabsortion after 6 and 12 months follow up. Integra® will be autologous neodermis. The authors recommend the dermal regeneration template for small or medium defects; in large defects they prefer autologous flaps with or without prosthesis.

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          Most cited references13

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          Artificial dermis for major burns. A multi-center randomized clinical trial.

          This communication presents an 11-center prospective randomized trial using the artificial dermis invented by Burke and Yannas. Patients with life-threatening burns who underwent primary excision and grafting within 7 days of injury had comparable sites randomized to receive either the artificial dermis (study site) or the investigator's usual skin grafting material (control site). Control materials were autograft, allograft, xenograft, or a synthetic dressing. Epidermal grafts were applied to the study site during a second operation, and surviving patients were followed for 1 year after grafting. One hundred thirty-nine sites on 106 patients were studied. Mean burn size was 46.5 +/- 15% mean total body surface (TBSA). Overall mortality was 13%, and mean hospital stay was 68 +/- 45 days. Median artificial dermis take was 80% compared with 95% for all comparative sites, but the take was equivalent to that of all nonautograft control materials. Results with the artificial dermis improved slightly as the investigators became more familiar with the material. Donor site thickness for the study site averaged .006'' +/- .002'' compared to .013'' +/- .018'' for control (p less than .0001) and the epidermal donor site healed an average of 4 days sooner (10 +/- 6 vs. 14 +/- 8 days) (p less than .0001). As the wounds matured during the first year, both patients and surgeons felt that both sites became more comparable in appearance and function. At the completion of the study, there was less hypertrophic scarring of the artificial dermis, and more patients preferred the artificial dermis to the control graft. Artificial dermis with an epidermal graft provides a permanent cover that is at least as satisfactory as currently available skin grafting techniques, and uses donor grafts that are thinner and donor sites that heal faster.
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            Reconstructive surgery using an artificial dermis (Integra): results with 39 grafts.

            Integra was initially developed for the primary coverage of acute burns. It acts as a network for dermal reconstruction. An epidermal graft overlay is necessary after 3 weeks to achieve the in vivo reconstruction of a full-thickness skin equivalent. The quality of the functional and aesthetic results achieved led us to evaluate the potential of Integra in the treatment of burn scars and for general reconstructive surgery. We present a series of 31 patients who underwent Integra grafting for reconstructive surgery at a total of 39 operational sites. The average area grafted per procedure was 267 cm(2). Complications (silicone detachment, failure of the graft, haematoma) were observed in nine cases. The length of follow-up ranged from 0.5 year to 4 years. Two patients (two sites) were lost to follow-up; the final results in the remaining patients were considered to be good in 28 cases, average in six cases and poor in three cases. The disadvantages of using Integra in reconstructive surgery are the necessity of two operations, the risks of infection under the silicone layer, of the silicone becoming detached and of recurrence of contraction. On the other hand, Integra has many advantages including its immediate availability, the availability of large quantities, the simplicity and reliability of the technique, and the pliability and the cosmetic appearance of the resulting cover. In the light of these preliminary results, Integra appears as a new alternative to full-thickness skin grafting, skin expansion and even skin flaps for reconstructive surgery. Copyright 2001 The British Association of Plastic Surgeons.
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              Reconstructive surgery with a dermal regeneration template: clinical and histologic study.

              Integra artificial skin was introduced in 1981 and its use in acute surgical management of burns is well established, but Integra has also been used in patients undergoing reconstructive surgery. Over a period of 25 months, the authors used Integra to cover 30 anatomic sites in 20 consecutive patients requiring reconstructive surgery and then analyzed the clinical and histologic outcomes. The most common reason for surgery was release of contracture followed by resurfacing of tight or painful scars. The authors assessed patients' satisfaction using a visual analog scale and scar appearance using a modified Vancouver Burn Index Scale. They evaluated the progress of wound healing by examining weekly punch-biopsy specimens with standard and immunohistochemical stains. Patients reported a 72 percent increase in range of movement, a 62 percent improvement in softness, and a 59 percent improvement in appearance compared with their preoperative states. Pruritus and dryness were the main complaints, and neither was improved much. Four distinct phases of dermal regeneration could be demonstrated histologically: imbibition, fibroblast migration, neovascularization, and remodeling and maturation. Full vascularization of the neodermis occurred at 4 weeks. The color of the wound reflected the state of neodermal vascularization. No adnexa, nerve endings, or elastic fibers were seen in any of the specimens. The new collagen was histologically indistinguishable from normal dermal collagen. The authors conclude that Integra is a useful tool in reconstructive surgery. The additional cost of its use can be justified by its distinct benefits compared with current methodology.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                September 2007
                : 33
                : 3
                : 195-199
                Affiliations
                [01] Barcelona orgnameHospital Valle de Hebrón orgdiv1Servicio de Cirugía Plástica España
                Article
                S0376-78922007000300007
                e9f0e4da-ce23-4436-89d5-53e1340119af

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 9, Pages: 5
                Product

                SciELO Spain


                Reparación tisular,Biomateriales,Contorno corporal,Tissular regeneration,Biomaterials,Body contour defects

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