Longitudinal assessment of Integra in primary burn management

A randomized pediatric clinical trial

Ludwik Branski, David Herndon, Clifford Pereira, Ronald P. Mlcak, Mario M. Celis, Jong Lee, Arthur P. Sanford, William Norbury, Xiao Jun Zhang, Marc G. Jeschke

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2615-2623
Number of pages9
JournalCritical Care Medicine
Volume35
Issue number11
DOIs
StatePublished - Nov 2007
Externally publishedYes

Fingerprint

Body Surface Area
Length of Stay
Randomized Controlled Trials
Pediatrics
Autografts
Burns
Cadaver
Bone Density
Energy Metabolism
Cicatrix
Allografts
Outcome Assessment (Health Care)
Skin
Acute-Phase Proteins
Pigmentation
Hospital Mortality
Infection
Body Composition
Cosmetics
Sepsis

Keywords

  • Allograft
  • Autograft
  • Burns
  • Children
  • Dual-energy radiograph absorptiometry
  • Integra
  • Reconstruction
  • Resting energy expenditure
  • Severe burns

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Longitudinal assessment of Integra in primary burn management : A randomized pediatric clinical trial. / Branski, Ludwik; Herndon, David; Pereira, Clifford; Mlcak, Ronald P.; Celis, Mario M.; Lee, Jong; Sanford, Arthur P.; Norbury, William; Zhang, Xiao Jun; Jeschke, Marc G.

In: Critical Care Medicine, Vol. 35, No. 11, 11.2007, p. 2615-2623.

Research output: Contribution to journalArticle

Branski, Ludwik ; Herndon, David ; Pereira, Clifford ; Mlcak, Ronald P. ; Celis, Mario M. ; Lee, Jong ; Sanford, Arthur P. ; Norbury, William ; Zhang, Xiao Jun ; Jeschke, Marc G. / Longitudinal assessment of Integra in primary burn management : A randomized pediatric clinical trial. In: Critical Care Medicine. 2007 ; Vol. 35, No. 11. pp. 2615-2623.
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abstract = "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.",
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AU - Herndon, David

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AU - Mlcak, Ronald P.

AU - Celis, Mario M.

AU - Lee, Jong

AU - Sanford, Arthur P.

AU - Norbury, William

AU - Zhang, Xiao Jun

AU - Jeschke, Marc G.

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N2 - 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.

AB - 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.

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KW - Autograft

KW - Burns

KW - Children

KW - Dual-energy radiograph absorptiometry

KW - Integra

KW - Reconstruction

KW - Resting energy expenditure

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