Strategies to improve the take of commercially available collagen/glycosaminoglycan wound repair material investigated in an animal model.

Integra Artificial Skin is becoming widely used in burns and reconstructive surgery. However, poor take and loss due to infection remains a concern for some patients. This study describes how the successful bio-integration of Integra Artificial Skin was accomplished in isolated full-thickness wounds in the pig, by the use of sequential protocol modifications that more intimately opposed the material to the wound bed. Further improvement was achieved by measures to reduce bacterial colonisation including the use of topical anti-microbial agents. The level of histologically confirmed Integra 'take' improved from close to zero to a mean 96% of wound area (+/-11 S.D.). The efficacy of this dermal wound bed was confirmed by the histological analysis of wounds after the subsequent application of extremely thin (<130 microm) widely meshed autologous split-thickness skin grafts. The results of this animal study support the recommendation that the bio-integration of Integra Artificial Skin is best achieved by the elimination of dead space below the material and by measures to hinder the penetration of microbes. The significant improvement in take achieved in this animal model using simple methodological refinements re-identifies priorities for the use of Integra Artificial Skin that can be applied in clinical management.