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Felix Mariano, Jr RCN MN PgDip Clinical Nurse Educator Clinical Nurse Specialist
ORL Head and Neck Surgery Auckland City Hospital Auckland, New Zealand [email protected]
Dermal Regeneration Template
Application & management
Economics
Applications & FUTURE
Bi-layer membrane system
Porous matrix of cross-linked fibers ◦ Bovine collagen
◦ Glycosaminoglycan
Silicone layer
Create or prepare a vascular bed
Apply Integra DRT
Acticoat Felix 7
VAC Dressing
Change every 7 days
Remove Silicon layer (Day 21)
Apply thin SSG
Mepitel
VAC Dressing
Remove 7 days
Integra could be an alternative
Integra could be an alternative if
donor site is a problem
Application in Head and Neck Surgery
Scalp SCC
6-8 hours of surgery
WLE Excision of lesion
Free flap reconstruction
2-3 weeks in hospital
OPC and District nursing input
Prepare wound bed
We DRILL!!!!!
Day 7
Day 14
Day 21
Day 7 post SSG
Day 7 post application
Day 14
Day 21
Day 7 post SSG application
Day 7 post SSG
Day 16 post SSG
1-2 months after
Reasonable cosmesis
complications……
Failed SSG
James J Johnston, Felix Mariano Jnr,
Rick Jaggi, Mark Izzard
Pt Tumour Stage Previous Reconstructions
Location Surgical bed
1 Cutaneous SCC T4 N1 M0 Nil Left Parietal Galea
2 Cutaneous SCC T4 N0 M0 Failed latissimus dorsi
Left Vertex Bone
3 Cutaneous SCC Tx N1 M0 Nil Right Parietal Bone
4 Cutaneous SCC T4 N0 M0 Nil Left Frontal Bone
5 Basal cell carcinoma T2 N0 M0 Nil Right Frontal Bone
6 Cutaneous SCC pT4a N0 M0
Nil Right Frontal/ Parietal
Bone
7 Cutaneous SCC T4 N2b M0 Lat dorsi free flap right side
Left Vertex Bone
8 Cutaneous SCC T2 N0 M0 Nil Left Parietal Bone
9 Cutaneous SCC pT2 N0 M0 Nil Right Parietal Bone
Results:
1.Mean age - 79 +/- 11.5 years (range, 63 to 89 years)
2.Resection and Application of Integra time – 108 +/- 42 mins
3.Harvest and fixation of split-thickness skin grafts were completed in an average of
77 +/- 32 minutes
4.Size of the scalp defect - ranged from 25 to 418cm2 - (mean of 157 +/- 140cm2)
5.Neodermal formation – 100%
6.Split skin graft applied - eight patients 39 +/- 26 days (1 left for secondary
healing)
7.Mean follow up period - 10 +/- 7 months (range, 1 to 24 months)
8.8/9 patients were still living – excellent graft take and cosmesis.
Free flap Reconstruction
Free flap surgery $50K + 2/52 hospital stay +
D/N visits +OPC DRT - $10K VAC - $3K 1/7 hospital stay
+ x3-5 OPC
Burns patients – well utilized
Large soft tissue resections
FUTURE
Non healing Leg ulcer
Non healing or deep cavities
http://www.ilstraining.com/idrt/idrt/brs_it_00.html