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Use of Integra Dermal Matrix in the Treatment of Combat Related Upper Extremity Soft Tissue Injuries
Jonathan Seavey, MD1; Zachary A. Masters, BS2; George C. Balazs, MD1; Derek F. Ipsen, DO1; George P. Nanos, MD1; Ian L. Valerio, MD, MS, MBA3; Scott M. Tintle, MD1
1Walter Reed National Military Medical Center, Bethesda, MD; 2Uniformed Service University of the Health Sciences, Bethesda, MD; 3The Ohio State University, Wexner Medical Center, Columbus, OH

Introduction: This is a retrospective review of patients with severe upper extremity combat wounds treated with Integra placement and autologous skin grafting.
Methods: Active duty patients treated with Integra Dermal Matrix for traumatic injuries of the upper extremity were identified in our local surgical scheduling system. All wounds were treated with a standard protocol of serial debridements until clean, continuous negative pressure wound therapy after application of Integra, and placement of split¬thickness or full¬thickness skin grafting after Integra incorporation. The primary outcome was wound healing. Percentage take of skin grafts was assessed as a secondary outcome. Univariate analysis (Mann¬Whitney U test for continuous variables and Fischer Exact test for categorical variables) was used to examine the effects of demographic and injury factors on healing rates.
Results: A total of 61 patients (69 wounds) met inclusion criteria. Mean age was 24.6 years, all were male, and 48% reported a pre¬injury history of tobacco use. Most patients sustained blast injuries. Six wounds were clinically infected with positive cultures ¬ all were treated with targeted antibiotic therapy and underwent successful skin grafting without recurrence of infection or graft failure. Median wound size was 56 square centimeters. 74% of wounds required a single application of Integra, 24% required a second and one wound required a third. Sixteen wounds were treated with full-thickness skin grafting. No wounds became infected during treatment and all healed successfully with primary skin grafting. A total of 53 wounds were treated with split¬thickness skin grafting. Among those, 49 of the 53 wounds had initial take assessed as greater than 95%: all went on to heal without incidence. Two wounds had graft take between 70% and 90%; they were treated with local wound care and went on to heal. Two skin grafts failed. On univariate analysis no association was found between failure to heal and wound size, wound location, presence of an open fracture, infection, number of operative debridements, time from injury to definitive closure, or any demographic factor.
Conclusion: Within our cohort, 97% of combat-related upper extremity wounds healed after treatment with serial debridement, Integra placement, and autologous skin grafting. We believe that this study validates the use of Integra in the treatment of upper extremity soft tissue wounds. Further study is needed to assess the long¬term functional outcomes of Integra treatment relative to traditional reconstructive procedures.

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