Uses for Integra Skin Graft Substitute

Integra is a product that is used to help re-grow skin on body parts where skin has been removed or badly damaged. It was initially used to safely cover large areas of burned tissue where skin needed to be regrown. However, Integra is now used far more widely as part of skin grafts in reconstructive surgery. Integra is sometimes referred to as a dermal matrix or dermal scaffold.

Purpose of Integra

Integra is used to help heal large wounds where skin has been injured and/or needs to be regrown. It was initially approved for patients who had extensive burns and who did not have enough donor skin to cover the damaged areas. It was later approved for the treatment of burn scars and diabetic foot ulcers that are resistant to treatment.

In addition to those FDA approved uses, Integra is widely used for other purposes. These include covering wounds in areas where a skin graft is not likely to work. In addition, Integra can be used to cover wounds on the extremities where tendons are exposed. It can also be used in areas where it is helpful to have thicker coverage than would be possible with skin grafts. For example, it is sometimes used to improve the appearance of the scar from a radial forearm phalloplasty. It can also be used in reconstruction after the removal of congenital nevi, particularly giant nevi. Congenital nevi are moles that are present at the time of birth, and which may need to be removed for either health or aesthetic reasons.

How Integra Works

The skin is made up of several layers. The innermost layer is the subcutaneous tissue which is made up of fat, connective tissues, and larger blood vessels. This is the layer on which Integra is placed. The middle layer of the skin is the dermis. This is the layer that the Integra skin graft matrix is designed to help rebuild. Finally, the top layer is the epidermis. This is the layer that contains skin pigments and what people think of when they talk about skin.

Like the skin, the Integra skin graft matrix is also made up of several layers. The main layer functions as a scaffold. When placed on an appropriate wound, blood vessels and other cells start to migrate into the matrix. Then they start to build a new layer of dermis inside the matrix. Over a period of around a month, the collagen that makes up much of the matrix is slowly replaced with collagen made by the body. At the same time, new blood vessels grow into the matrix to supply the growing dermis.

Once the dermis contained in the Integra matrix has all the blood supply it needs, it can be covered with a split-thickness skin graft. However, until then, the new dermis needs an alternative source of protection. This takes the form of the second layer of Integra—a silicone sheet. This sheet protects the wound and the growing skin. It reduces the risk of infection and keeps everything moist and safe.

Risks and Contraindications for Integra

As Integra includes bovine (cow) collagen, it should not be used by patients who are sensitive to bovine collagen or chondroitin. It is not recommended for use in third-degree burns. Integra may not be a good option for individuals who have recently undergone radiation treatment, as there is some evidence that it may not take as well on irradiated wounds. However, it may be reasonable to use Integra prior to radiation treatment, as it can survive that treatment.

A common complication of Integra use is hematoma or seroma formation. Both of these involve the collection of fluid (either blood or serum). If this happens, the fluid will need to be removed by a healthcare provider. This can often be done with a needle, but may require the Integra to be cut to remove a larger or more solid clot. Infection is another potential risk, and this can lead to the Integra not taking properly. If the matrix does not stick appropriately to the wound it may need to be removed and replaced. Finally, in some cases, the silicone sheet will start to separate early. This may require the skin graft to be performed sooner than anticipated, but only if the new dermis has a good blood supply.

There are some cases where Integra is used for both aesthetic reasons as much as for potential functional benefits. One example of this is using Integra to reduce the depth of the scar after a radial forearm free-flap is used for reconstruction. In these cases, it's important to recognize that the benefits of Integra come with an important trade-off—the need for an extra procedure under general anesthesia. This is because instead of covering the wound with a skin graft during the initial procedure, the skin graft must wait until the body has built new blood vessels into the Integra matrix.

Is Integra Right for You?

If you have experienced a large wound from a burn, cancer, or other cause, your healthcare provider may discuss whether Integra is a good option for you. There are a number of factors that the practitioner may consider including the

• Size of the wound
• Wound location
• Availability of donor skin
• Type or cause of the wound
• Need for/access to negative pressure wound therapy

In certain cases, such as specific types of burns and diabetic foot ulcers, Integra may be the clear choice. In others, there may be both pros and cons to using a dermal matrix as part of reconstructive surgery. One potentially significant downside is cost. Insurance companies will often only cover Integra and similar products under very specific circumstances. Another is the need for additional procedures if without the use of Integra the wound could be closed in a single surgery. Discussing the advantages and disadvantages with your healthcare provider can help you make the decision that is right for you.