Integra™ permits early durable coverage of improvised explosive device (IED) amputation stumps

Area of Science:

• Military Medicine
• Reconstructive Surgery
• Trauma Management

Background:

• Improvised explosive device (IED) blasts result in severe injuries, including multiple amputations, extensive soft tissue loss, and contaminated open fractures.
• Survivors often face complex reconstructive challenges due to the nature of battlefield wounds.

Purpose of the Study:

• To evaluate the early experience and efficacy of Integra™ in the acute management of military personnel with improvised explosive device (IED) injuries.
• To assess Integra™ as a reconstructive option for severe combat-related wounds, particularly those involving amputations and significant soft tissue defects.

Main Methods:

• A prospective review of clinical records for patients with IED injuries treated with Integra™ between August and December 2009.
• Data collection focused on patient demographics, injury characteristics, number of prior procedures, timing of Integra™ application, wound size, and anatomical locations reconstructed.

Main Results:

• Seven male soldiers (mean age 26) with trunk and limb injuries, including multiple amputations, were treated.
• Integra™ was applied 6-24 days post-injury (mean 13 days) to wounds ranging from 1-11.5% total body surface area (TBSA).
• Partial graft take occurred in 2 patients (3 wounds), with all wounds eventually healing satisfactorily after delayed split skin grafting.

Conclusions:

• IEDs cause extensive contamination and soft tissue damage, presenting a physiological insult comparable to severe burns with limited donor sites.
• Integra™ facilitates timely wound closure in the acute phase, minimizing operative time and morbidity compared to complex procedures like microvascular flaps.
• Early application of Integra™ can provide robust tissue coverage, promoting faster rehabilitation and return to duty for military casualties.