Branski LK, Herndon DN, Pereira C, Mlcak RP, Celis MM, Lee JO, Sanford AP, Norbury WB, Zhang XJ, Jeschke MG, et al.
Critical care medicine. Date of publication 2007 Nov 1;volume 35(11):2615-23.
1. Crit Care Med. 2007 Nov;35(11):2615-23.
Longitudinal assessment of Integra in primary burn management: a randomized
pediatric clinical trial.
Branski LK(1), Herndon DN, Pereira C, Mlcak RP, Celis MM, Lee JO, Sanford AP,
Norbury WB, Zhang XJ, Jeschke MG.
Author information:
(1)Shriners Hospitals for Children, Galveston, TX, USA.
Comment in
Crit Care Med. 2007 Nov;35(11):2661-2.
BACKGROUND: Early excision with autograft-allograft closure is standard in severe
burn management. Cadaver skin is associated with risks such as antigenicity,
infection, and limited availability and shelf life. Previous studies have shown
that Integra is safe to use in burns of <20% total body surface area. However,
the suitability of its use in large burns (>50% total body surface area), its
effects on postburn hypermetabolism, and the long-term cosmetic and functional
results have not yet been evaluated.
MATERIALS AND METHODS: Twenty children with an average burn size of 73 +/- 15%
total body surface area (71 +/- 15% full-thickness burn) were randomized to be
treated with either Integra or with autograft-allograft technique. Outcome
measures such as length of hospital stay, mortality, incidence of infection and
sepsis, acute phase protein levels, and muscle fractional synthetic rate were
compared between and within groups during the acute stay (admission to
discharge). Outcome measures such as resting energy expenditure, body composition
data (measured by dual-energy radiograph absorptiometry), cardiac function
indexes, and number of reconstructive procedures were compared during acute
hospital stay and at long-term follow-up (up to 2 yrs postinjury). Scar
evaluation was performed at long-term follow-up.
RESULTS: There were no significant differences between Integra and controls in
burn size (70 +/- 5% vs. 74 +/- 4% total body surface area), mortality (40% vs.
30%), and length of stay (41 +/- 4 vs. 39 +/- 4 days). In the short term, resting
energy expenditure significantly decreased (p < .01), and serum levels of
constitutive proteins significantly increased (p < .03) in the Integra group
compared with controls. Long-term follow-up revealed a significant increase in
bone mineral content and density (24 months postburn, p < .05), as well as
improved scarring in terms of height, thickness, vascularity, and pigmentation
(12 months and 18-24 months, p < .01) in the Integra group.
CONCLUSION: Integra can be used for immediate wound coverage in children with
severe burns without the associated risks of cadaver skin.
DOI: 10.1097/01.CCM.0000285991.36698.E2
PMID: 17828040 [Indexed for MEDLINE]
