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Dermal Biological Scaffold and Regenerate for Traumatic Wound Coverage - A Case Series of 240 Wounds
Ian Valerio, MD1, Jennifer Sabino, MD2, Jonathan Seavey, MD2, Zachary Masters, BS2, George Balazs, MD2, Scott Tintle, MD2, Mark Fleming, DO2.
1The Ohio State University Wexner Medical Center, Columbus, OH, USA, 2Walter Reed National Military Medical Center, Bethesda, MD, USA.

PURPOSE:
Bioartificial dermal regeneration templates (DRTs) have been used extensively in burn treatment, but few studies have reported their use in combat wounds. Combat injuries represent devastating wounds that require restoration of the protective skin barrier while preserving function of exposed muscle, tendons, and nerves. This study reports the impact and outcomes of DRTs in the reconstruction of traumatic combat extremity wounds.
METHODS:
An IRB approved retrospective review of patients treated with Integra DRT (Integra Lifesciences Corporation, Plainsboro, NJ) for combat-related wounds from 2009 through 2013 was completed. The primary outcome investigated was healing of wounds following DRT placement, as measured by successful take or stable coverage with skin grafting, flap procedure, or in the cases of delayed primary closure, healing of the closed wound.
RESULTS:
One-hundred-ninety patients with 280 wounds met inclusion criteria, of which 251(90%) had complete records. Patients underwent a median of three irrigation and debridement procedures prior to DRT placement over a median of eight days. The median time from DRT placement to definitive closure was 15 days. The median time from injury to definitive closure was 35 days. Overall healing rate after first attempt definitive closure was 86%.
CONCLUSION:
Bioartificial DRTs have played an increasing role in the treatment of traumatic war wounds. Utilizing the biologic scaffold, our clinical group has been able to successfully achieve definitive closure of wounds complicated by avascular tissue while maintaining adequate function. This study reports the largest consecutive case series of DRTs employed for traumatic injuries in the literature.


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