Integra™ Wound Matrix and Bilayer Wound Matrix TRAUMA CASE STUDIES LIMIT UNCERTAINTY

Limit uncertainty with a matrix designed for immediate wound closure. Integra™ Bilayer Wound Matrix is an advanced wound care device comprised of a porous matrix of cross-linked bovine tendon collagen and glycosaminoglycan and a semi-permeable polysiloxane (silicone) layer. The semi-permeable silicone membrane controls water vapor loss, provides a flexible adherent covering for the wound surface, and adds increased tear strength to the device. It provides a scaffold for cellular invasion and capillary growth. The scaffold is eventually remodeled as the patient's cells rebuild the damaged site....

Summary of Wound Bed Preparation • A prepared wound bed must be free from contamination and infection. All necrotic and devitalized tissue must be removed. Pre-Operative routines should follow normal surgical center protocols. This may include the use of systematic broad spectrum antibiotics. If wound infection is detected, treat topically and/or systemically according to unit protocols. • The wound bed must be dry with no signs of bleeding. Meticulous hemostasis needs to be achieved to prevent hematomas or excessive fluid accumulation. Epinephrine, pinpoint electrocaudary, thrombin spray, thrombin-...

Clinical Sequence Day 0: Pre-Treatment All traumatic wound patients must have accurate diagnosis and treatment of underlying disease and risks. There must be thorough pre-operative control of inflammation, ulceration, debris and bioburden, and edema (as best as the disease and available treatments permit). Day 1: 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...

Surgeon Profiles Vineet Mehan, MD Dr. Mehan completed his doctorate in medicine from the MCP-Hahnemann School of Medicine, Drexel University in 2000. As a resident, he trained in the Department of Surgery from 2000-2005 at Einstein Medical Center and in the Department of Plastic Surgery from 2005-2008 at Brown University. Dr. Mehan has been in private practice at the Greater Washington Plastic Surgery Associates since 2008. Dr. Mehan’s Case Studies are featured on pages 12-17 Robert Reddix, MD Dr. Reddix obtained his doctorate of medicine from the Baylor College of Medicine, Houston, Texas. He...

Case Study 1 Case study and pictures courtesy of Robert Reddix, MD, Fort Worth, Texas Type of Wound: Left open pilon fracture with a traumatic opening measuring 10 cm Mechanism of Injury: Motor vehicle accident with ejection Patient: 14 year-old female The patient is a 14 year-old female involved in a motor vehicle accident with ejection. In addition to her traumatic brain injury, she also suffered a left open pilon fracture with the traumatic opening initially measuring 10 cm x 4 cm (Figures 1-1 and 1-2). On the night of presentation, she underwent irrigation and debridement of her wound. There...

Case Study 2 Case study and pictures courtesy of Robert Reddix, MD, Fort Worth, Texas Type of Wound: Grade III B open tibia fracture Mechanism of Injury: Gun shot wound with a large caliber handgun at close range Patient: 23 year-old male The patient is a 23 year-old African American male who was shot in his left tibia at close range with a large caliber handgun. On the date of injury, he underwent irrigation and debridement of his traumatic wound (Figures 2-1 and 2-2). He also received placement of a leg spanning external fixator device and application of Negative Pressure Wound Therapy (NPWT)...

Case Study 3 Case study and pictures courtesy of Robert Reddix, MD, Fort Worth, Texas Type of Wound: Below the knee amputation Mechanism of Injury: Motorcycle accident Patient: 51 year-old female The patient is a 51 year-old female involved in a motorcycle accident. As a result of her multiple orthopaedic injuries, she underwent a left below knee amputation that subsequently became infected with fungal species (Figures 3-1 and 3-2). After multiple debridements and culture specific intravenous antibiotics to clear her infection, Integra was placed over the area with placement of Negative Pressure...

Case Study 4 Case study and pictures courtesy of Daniel R. Schlatterer, DO, MS; Atlanta, GA Type of Wound: Grade III B open tibia fracture Mechanism of Injury: Tour bus operator, the bus rolled over Patient: 40 year-old male, otherwise healthy The patient is a 40 year-old male who was injured when the tour bus he was driving rolled over. He was admitted to the trauma service with closed fractures of the humerus, acetabulum, femur, and a grade III B tibia fracture (III B indicating an open fracture requiring bony coverage with a local or free muscle flap). Debridement took place immediately upon...

Case Study 5 Case study and pictures courtesy of Daniel R. Schlatterer, DO, MS, Atlanta, GA Type of Wound: Mangled lower extremity Mechanism of Injury: Motorcycle collision Patient: 48 year-old male, otherwise healthy The patient was involved in a motorcycle collision in September of 2008. The mangled lower extremity could not be salvaged (Figure 5-1) and a Below Knee Amputation (BKA) was performed at an outside facility. The remaining muscles were rearranged to cover the tibial stump, however there was insufficient skin to cover the muscle (Figure 5-2). The muscle bed was healthy enough to support...

Case Study 6 Case study and pictures courtesy of Daniel R. Schlatterer, DO, MS, Atlanta, GA Type of Wound: Open Ankle Fracture with additional exposed muscle, tendon, and bone proximal to the ankle fracture Mechanism of Injury: Blunt trauma in a factory setting Patient: 34 year-old female, otherwise healthy The patient is a 34 year-old female who suffered blunt trauma to her leg while in a warehouse. The patient was treated within 24 hours of admission with debridement and definitive fixation of the ankle fracture. At this same index surgery, Integra was applied in conjunction with Negative Pressure...