felix mariano, jr rcn mn pgdip clinical nurse educator
TRANSCRIPT
Felix Mariano, Jr RCN MN PgDip Clinical Nurse Educator Clinical Nurse Specialist
ORL Head and Neck Surgery Auckland City Hospital Auckland, New Zealand [email protected]
Dermal Regeneration Template
Application & management
Economics
Applications & FUTURE
Bi-layer membrane system
Porous matrix of cross-linked fibers ◦ Bovine collagen
◦ Glycosaminoglycan
Silicone layer
Create or prepare a vascular bed
Apply Integra DRT
Acticoat Felix 7
VAC Dressing
Change every 7 days
Remove Silicon layer (Day 21)
Apply thin SSG
Mepitel
VAC Dressing
Remove 7 days
Integra could be an alternative
Integra could be an alternative if
donor site is a problem
Application in Head and Neck Surgery
Scalp SCC
6-8 hours of surgery
WLE Excision of lesion
Free flap reconstruction
2-3 weeks in hospital
OPC and District nursing input
Prepare wound bed
We DRILL!!!!!
Day 7
Day 14
Day 21
Day 7 post SSG
Day 7 post application
Day 14
Day 21
Day 7 post SSG application
Day 7 post SSG
Day 16 post SSG
1-2 months after
Reasonable cosmesis
complications……
Failed SSG
James J Johnston, Felix Mariano Jnr,
Rick Jaggi, Mark Izzard
Pt Tumour Stage Previous Reconstructions
Location Surgical bed
1 Cutaneous SCC T4 N1 M0 Nil Left Parietal Galea
2 Cutaneous SCC T4 N0 M0 Failed latissimus dorsi
Left Vertex Bone
3 Cutaneous SCC Tx N1 M0 Nil Right Parietal Bone
4 Cutaneous SCC T4 N0 M0 Nil Left Frontal Bone
5 Basal cell carcinoma T2 N0 M0 Nil Right Frontal Bone
6 Cutaneous SCC pT4a N0 M0
Nil Right Frontal/ Parietal
Bone
7 Cutaneous SCC T4 N2b M0 Lat dorsi free flap right side
Left Vertex Bone
8 Cutaneous SCC T2 N0 M0 Nil Left Parietal Bone
9 Cutaneous SCC pT2 N0 M0 Nil Right Parietal Bone
Results:
1.Mean age - 79 +/- 11.5 years (range, 63 to 89 years)
2.Resection and Application of Integra time – 108 +/- 42 mins
3.Harvest and fixation of split-thickness skin grafts were completed in an average of
77 +/- 32 minutes
4.Size of the scalp defect - ranged from 25 to 418cm2 - (mean of 157 +/- 140cm2)
5.Neodermal formation – 100%
6.Split skin graft applied - eight patients 39 +/- 26 days (1 left for secondary
healing)
7.Mean follow up period - 10 +/- 7 months (range, 1 to 24 months)
8.8/9 patients were still living – excellent graft take and cosmesis.
Free flap Reconstruction
Free flap surgery $50K + 2/52 hospital stay +
D/N visits +OPC DRT - $10K VAC - $3K 1/7 hospital stay
+ x3-5 OPC
Burns patients – well utilized
Large soft tissue resections
FUTURE
Non healing Leg ulcer
Non healing or deep cavities
http://www.ilstraining.com/idrt/idrt/brs_it_00.html