Incidence and microbiology of infectious complications with the use of artificial skin Integra® in burns

Integra(R) dermal substitute is used as biomaterial after thermal injury. This artificial skin allows temporary coverage after burns excision, transformation of matrix in neo dermis and definitive engraftment. Infections are the most common complication of this technique. The objectives were to evaluate incidence of sepsis, to analyse microbiology and risk factors of developing Integra(R) infections. Patients with acute burns and indications of Integra(R) during five years were retrospectively enrolled. Demographic data, surgical procedures and microbiologic biopsies were collected. Fifty patients (40 +/- 15 years) were studied and 71 surgical procedures using Integra(R) were performed. Burns were extended 45 +/- 21% total body surface area. Placement of Integra(R) was made 15 +/- 11 days after burns and autografts 31 + 9 days after placement of Integra(R). Twenty-one patients had infected Integra(R) (42% of population). A total of 23 Integra(R) infected sites were observed (15 local and eight invasive). Diagnosis of infection was made after 13 +/- 5 days using quantitative cultures. Other sites of infection were respiratory tract (46 pneumonias) and others burned wounds (17 infections outside of Integra(R)). Any risk factor was identified between burns who developed Integra(R) infections and the others. Incidence of infected Integra(R) was higher than in previous studies. Delayed application of Integra(R) after burns could explain higher incidence of infection. Pseudomonas aeruginosa and Staphylococcus aureus were more frequently isolated than other pathogens. Standardized technique for wounds coverage with Integra(R) is necessary to reduce incidence of infections and improve functional results in burns patients. (C) 2008 Elsevier Masson SAS.