EXPERIENCE WITH INTEGRA® AT THE PRAGUE BURNS CENTRE 2002-2016.

INTRODUCTION: Integra® dermal replacement has a wide spectrum of use both in burn medicine as well as in reconstructive plastic surgery and traumatology. Since 2002, it has been a part of surgical treatment of patients at Prague Burns Centre of the Královské Vinohrady Teaching Hospital.

STUDY GROUP: Integra® was used in 47 patients in total between years 2002 and 2016. In this group there were 28 paediatric patients and 19 adult patients. Eleven children were operated during the reconstructive period, 8 children had an acute injury. There were 11 adult patients with Integra® applied within the trauma treatment, another 9 during reconstructive surgery. In 2016, we examined 11 patients treated by Integra®, at least 2 years ago. The average time since the application was 9 years. All examined patients had Integra® primarily applied to treat an acute injury.

METHOD: Scars after the application of Integra® were compared with scars after dermoepidermal grafts (DE) in respective patients. Evaluation was performed on the basis of subjective and objective assessment by means of the modified Vancouver Scale (VSS). Samples were submitted for a histological and immunohistochemical analysis.

RESULTS: Areas with Integra® coverage scored 1.4 points on average on the VSS. The scars after dermoepidermal graft scored 4 points on the same scale. Subjective assessment of functional and cosmetic quality of scars by patients was better in all cases in comparison to DE grafting. Notable differences were found between scars following Integra® application and those after DE grafting on histological assessment, namely in the organization and quality of collagen and elastin fibres as well as in tissue revascularization.

CONCLUSION: The Integra® artificial skin replacement is a part of surgical strategy in management of extensive burn trauma and plays an important role in reconstructive surgery. The resulting scar quality when using Integra® seems to be better than in DE grafting both from an objective and subjective points of view..