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Biomaterial Appears Useful in Certain Head and Neck Surgery Wound Repairs

by Ed Susman •

  • It improves cosmetics outcomes by reducing scarring.
  • It allows for immediate closure over muscle, cartilage, and fascia.
  • There is less tissue manipulation required.
  • Donor site morbidity is reduced.
  • Operative time is decreased.
  • The area being repaired returns to normal function more quickly.
  • The need for surgeons to prematurely commit to labor-intensive reconstructions is lessened.

Biological skin substitutes decrease bacterial counts, slow loss of water, protein and electrolytes, reduce pain and help restore function. In addition these skin substitutes can prevent the dessication of nerves, blood vessels, and tendons. Dr. Saigal said. The mainstay of research and development of these biological skin substitutes is for use in wound healing and burns. They represent a new experience in reconstructive head and neck surgery. There is less experience in reconstruction but it does provide us with a multitude of new options.

Mechanisms of Function

Dr. Saigal said that the product was initially approved by the FDA in 2001. Integra consists of a 100-micrometer-thick epidermis layer of polysiloxane, a three-dimensional porous matrix of cross-linked bovine tendon type I collagen, and glycosaminoglycan. The Integra sheet is placed on the wound and is sutured into place along the sides and the center, Dr. Saigal explained when asked by doctors to more fully describe how it works. The dermal template allows for ingrowth of fibroblasts, macrophages, and epithelial cells into the wound bed. In addition, a top layer of the template prevents moisture loss just like the native epidermis, he said.

Eventually the original template degrades and can be easily removed after two to three weeks. He said that the results show superior cosmetic results when compared to outcomes seen with split-thickness skin grafts.

Exactly how the process works to build new skin, Dr. Saigal said, is still not completely understood. It is believed that improved cell migration is enhanced by fibroblast proliferation and that glycosaminoglycans bind to tissue growth factors, suppressing the inflammatory phase of wound healing. The tissue formed has a high density of blood vessels that actually resembles normal dermis, with the exception of sebaceous glands and follicles, he said.

He illustrated one patient with a nasal growth that required massive excision that included considerable anatomic structures, yet the outcome appeared virtually normal. In head and neck surgery, we envision using Integra for surgical defects not amenable for closure due to their size or location, in radiated fields, for improved skin graft survivability, for conventional cancer excision where tissue margins have been deferred to permanent section, and for patient in extremes of age-young children or the elderly-where rapid healing is desirable, he said.