LIMIT UNCERTAINTY Day o: Pre-Treatment All chronic wound patients must have accurate diagnosis and treatment of underlying disease and risks. There must be thorough preoperative control of inflammation, ulceration, debris and bioburden, and edema (as best as the disease and available treatments permit). Day i: Debridement Prepare wound bed using standard methods to ensure wound is free of debris and necrotic tissue. Regardless of how well the wound has been prepared and how healthy it looks, Integra Bilayer Wound Matrix must not be placed on an existing wound surface. The entire existing wound must be completely excised or surgically debrided to ensure the wound bed and edges contain viable tissue.

Clinical Sequence of Integra Bilayer Wound Matrix Day 7-14: Cellular Invasion And Capillary Growth Integra Bilayer Wound Matrix is applied to the excised wound bed. Fluids invade the matrix within minutes of application, adhering it to the wound. The IBWM must conform to and contact the wound surface. Tension within the material will shear the matrix from the silicone, so the material must not be stretched. It can be affixed with sutures, staples, or any suitable alternative. Dermal cells begin migrating into the matrix and establish a new vascular network. The scaffold is eventually remodeled...

Clinical Sequence of Integra Bilayer Wound Matrix INTEGRA LIMIT UNCERTAINTY Day 21+: Silicone Removal Day 21-56+: Wound Closure The silicone layer is removed. Epidermal cells migrate from the wound edges to complete wound The collagen template biodegrades and is absorbed into the body. closure. For larger wounds, a thin epidermal autograft may be considered to facilitate wound closure. A thin 0.004 - 0.006 in. (0.1016 - 0.1524 mm) epidermal autograft may be applied over the new remodeled skin.

Clinical Sequence of Integra Bilayer Wound Matrix INTEGRA LIMIT UNCERTAINTY Day 21-56+: Wound Closure Epidermal coverage over the wound yields a permanant and lasting wound closure