Always handle Integra® Meshed Dermal Regeneration Template using aseptic technique. Peel open the outer pouch and remove the inner foil pouch using sterile technique. Place foil pouch flat on a sterile surface and peel it open. Remove product, including the protective polyethylene cover sheets. While holding the product with the tab, remove one polyethylene cover sheet. Turn the product and remove the second polyethylene cover sheet. Using the tab, the product can now be placed into a basin containing sterile saline solution. Carefully remove the tab from the product. Rinse the product by immersion in sterile saline for one to two minutes. Keep product in the basin until application.

Wound Excision
Excision must be made to the level of viable tissue and meticulous hemostasis must be achieved before application of Integra® Meshed Dermal Regeneration Template. Excisional techniques for Integra® Meshed Dermal Regeneration Template sites can be fascial, sequential or tangential. It is absolutely critical to the successful take of Integra® Meshed Dermal Regeneration Template that excision be complete and that no devitalized tissue remains. Complete hemostasis must be achieved before application of Integra® Meshed Dermal Regeneration Template. The presence of hematoma will cause loss of Integra® Meshed Dermal Regeneration Template in the affected area. Broad area cauterization that could decrease wound bed viability should be avoided.

Shaping Integra® Meshed Dermal Regeneration Template to Fit the Wound
Integra® Meshed Dermal Regeneration Template should be shaped accurately to fit the excised wound margins to minimize scarring at these margins. It should not be overlapped onto non-excised areas or onto other sheets of Integra® Meshed Dermal Regeneration Template. It is easily cut with sterile scissors by placing the sheet of Integra® Meshed Dermal Regeneration Template over the excised wound bed and cutting exactly to the edge.

Applying Integra® Meshed Dermal Regeneration Template to the Wound
It is critical that the collagen template layer be in direct contact with the excised wound. The silicone layer (identified by the black threads) must be placed out (away from the wound bed). Do not apply upside down; the black threads must be clearly visible. For optimal cosmetic results, place the Integra® Meshed Dermal Regeneration Template so that the suture lines between Integra® Meshed Dermal Regeneration Template sheets lie in Langer's lines. This will minimize the final appearance of the suture lines.

The Integra® Meshed Dermal Regeneration Template sheets are secured by staples or sutures placed in an interrupted fashion under slight tension. If the Integra® Meshed Dermal Regeneration Template has been meshed, care must be taken not to spread the mesh. Care should be taken to achieve a primary closure between Integra® Meshed Dermal Regeneration Template and adjacent unburned skin or between sheets of Integra® Meshed Dermal Regeneration Template. Suture or staple each sheet of Integra® Meshed Dermal Regeneration Template in place independently. The Integra® Meshed Dermal Regeneration Template sheets may also be affixed to one another to assure that there is no gap between sheets. Adjust the area to ensure that there is no undue tension on an individual piece of Integra® Meshed Dermal Regeneration Template. The material should readily adhere and conform to the wound surface. Any air bubbles should be carefully removed by moving them to the edge of the sheet. Dressings should be applied over Integra® Meshed Dermal Regeneration Template according to the protocol of the practitioner.

The inner dressing need not be disturbed unless there are problems requiring intervention. The attachment of the silicone layer should be examined. An antibacterial dressing may be used or the outer dressing can be soaked in an appropriate antimicrobial solution.

There should be no hydrotherapy immersion of the patient following Integra® Meshed Dermal Regeneration Template application while the silicone layer is in place. Mechanical dislodgment of Integra® Meshed Dermal Regeneration Template should be avoided. Ambulation and physical therapy can be instituted according to the condition of the patient and judgment of the practitioner. All Integra® Meshed Dermal Regeneration Template sites must be securely covered with dressings before ambulation and/or physical therapy.

Staples or sutures should remain in place until the time of epidermal autografting. The staples or sutures help secure the silicone layer and decrease the likelihood of premature silicone layer separation.

The silicone layer of Integra® Meshed Dermal Regeneration Template may be removed when the collagen layer has been replaced by neodermis, usually 14 to 21 days after application. Removal of the silicone layer and grafting may take place immediately after formation of the neodermis, if epidermal autograft is available. The removal of the silicone layer may be postponed until donor sites for epidermal autograft area are available.

The clinician must be careful when removing the silicone layer. The silicone layer can usually be removed using only forceps. Generally, it should peel off easily. Difficulties in removal may indicate that neodermis formation is incomplete. However, if the silicone is difficult to remove, a forceps and scalpel may be used to gently separate the silicone layer from the neodermis. Caution must be employed to not remove the newly formed neodermal tissue when removing the silicone layer. Integra® Meshed Dermal Regeneration Template must not be excised off the wound.

Harvesting and Preparation of the Epidermal Autograft
Epidermal autograft can be taken from sites unsuitable for conventional autograft, for example small areas from which a large intact sheet would be impossible. If possible, the area should be matched for color and type of skin.

A thin epidermal autograft should be taken at a thickness just sufficient to provide punctate bleeding of the donor site, typically 0.004"-0.006" (0.10mm-0.14mm). Dermal tissue is not needed in the epidermal autograft and should be minimized.

Typically, the thin epidermal autograft may be meshed up to a 4:1 ratio. The meshed epidermal
autograft may be fragile and care should be taken in handling the graft.

Application of the Epidermal Autograft to the Neodermis
The epidermal autograft should be placed over the neodermis by spreading the meshed autograft. It should be spread as evenly as possible over the neodermis without leaving large open areas.

Completion of the epidermal autograft procedure should follow the standard protocol for full sheet or meshed autograft. The epidermal autograft should be anchored by sutures or staples. The dressing over the epidermal autograft should be similar to that used over conventional meshed autograft.