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Wound Bed Preparation
  Application
  Post-Op Care
Summary
   

Summary
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In this section, you have learned:

  • In preparation for INTEGRA™ Bilayer Matrix Wound Dressing application, the wound is debrided or excised to viable tissue and INTEGRA™ Bilayer Matrix Wound Dressing is applied. Over the next 2-4 weeks, the dermal layer is remodeled while simultaneously degrading the collagen-GAG matrix. The biodegradable template induces organized remodeling of tissue by the body. After the silicone layer is removed, a thin epidermal autograft 0.004-0.006 inches (0.1016 - 0.1524 millimeters) may be applied. As shown, engraftment and confluence of the epidermal graft may complete the wound closure in about 30 days.
  • In section 2, wound bed preparation, we stressed that a prepared wound bed must be free from contamination and infection. All necrotic and devitalized tissue must be removed. You must achieve an adequate vascular supply prior to the application of INTEGRA™ Bilayer Matrix Wound Dressing. Meticulous hemostasis must also be achieved to prevent hematomas or excessive fluid accumulation. To ensure intimate contact with INTEGRA™ Bilayer Matrix Wound Dressing the wound bed must be uniform and flat. The wound bed must be dry with no signs of bleeding. You should achieve level tissue planes and when necessary, marsupializing edges to avoid large step-offs between the wound bed and normal skin.
  • In section 3, application, you learned to estimate the number and size of sheets, as well as prepare the product for application. You can mesh sheets 1:1 through a "non-crushing" mesher (e.g. Brennen®) but do not expand. Do not try to move or "float" sheets like a STSG, instead, lift sheets up and reposition. Place sheets on prepared wound bed, secure parallel to inside edge of wound bed and trim excess. Fix sheets independently and/or secure adjacent sheets together to minimize gaps, reducing granulation tissue formation. It is recommended that dressings be built in layers while checking under dressings frequently.
  • In section 4, post-op care, the appearance of the INTEGRA™ Bilayer Matrix Wound Dressing will vary. The rate and progression of the color change depends on the patient and rate of healing. Generally, the color will change through a progression from red to pink to orange/peach to vanilla. The goal of the dressings is to protect the INTEGRA™ Bilayer Matrix Wound Dressing by preventing shearing and dislodgement, while still enabling routine visual examination. Dressings should be built in layers to protect the INTEGRA™ Bilayer Matrix Wound Dressing site from shear and infection. When removing dressings to inspect INTEGRA™ Bilayer Matrix Wound Dressing sites, care should be taken to avoid dislodgement. You should inspect INTEGRA™ Bilayer Matrix Wound Dressing by checking seams, interstices, and edges for signs of hematomas, infection, fluid accumulation, silicone layer separation, and areas of non-take on a regular basis. Your visual inspection regimen should include recognition of healing wound tissue as well as the ability to identify the various complications that may arise. Early and swift intervention of these complications will help in the successful take of the product.

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