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Wound Bed Preparation
 
    Application Guidelines
    Estimating the Number and Size of Sheets
    Product Preperation
    Meshing and Handling
    Placement, Shaping and Cutting
    Stapling and Suturing
    Dressings
 
  Post-Op Care
  Summary
   

Application - Section Summary
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In this section, you have learned:

  • Estimate the number and size of sheets, and anticipate when the product will be needed. Anticipate when the product will be needed and begin rinsing sheets to allow for a 1-2 minute hydration in saline before wound bed prep has been completed. Follow product preparation protocol as outlined in this course. When removing the INTEGRA™ Bilayer Matrix Wound Dressing from the foil pouch use gloved hands (do not use instruments).
  • If meshing INTEGRA™ Bilayer Matrix Wound Dressing use 4 x 10 inch sheets to avoid folding. Mesh sheets 1 : 1 through a "non-crushing" mesher (e.g. Brennen®) but do not expand. This technique minimizes fluid accumulation under the graft, minimizes amount of graft loss in the event of hematoma and minimizes the risk of graft loss in the event of bacterial colonization.
  • When placing, shaping and cutting the INTEGRA™ Bilayer Matrix Wound Dressing gently remove sheets from the holding basin with gloved hands and place directly onto the wound bed. Do not try to move or "float" sheets like a STSG, instead, lift sheets up and reposition. Place sheets on prepared wound bed, affix parallel to inside edge of wound bed and trim excess; or, place sheet on prepared wound bed, trim sheet to fit site, and affix perpendicular to seam (place staples across seams). Cut sheets to avoid gaps and be sure to place seam lines along Langer's Lines to reduce risk of contracture. Make sure INTEGRA™ Bilayer Matrix Wound Dressing lays flat with no wrinkles or bubbles.

  • In a staged procedure, do not place INTEGRA™ Bilayer Matrix Wound Dressing in contact with non-viable tissue, rather maintain a safety margin between the prepared wound bed and any non-viable tissue.
  • Stapling, suturing or other suitable alternative may be used when applying INTEGRA™ Bilayer Matrix Wound Dressing, however with either technique remove all air bubbles. Fix sheets independently and/or affix adjacent sheets together to minimize gaps, reducing granulation tissue formation. Interrupted stapling (i.e., leaving a 1-2 centimeter space between staples) can be used to seal edges.
  • It is recommended that dressings be built in layers and to inspect for hematoma and seroma formation upon dressing changes. The elastic net dressing can be attached by staples or other suitable methods. It will be left in place until the silicone is removed. When applied correctly, the expanded interstices will be open about 1-2 cm and the silicone will have slight indentations from the elastic net dressing.

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