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354 TREATMENT OF A RECURRENT AND INTRACTABLE KELOID WITH EXCISION AND PLACEMENT OF INTEGRA DERMAL MATRIX: RESULTS AND RATIONALE.
  1. B. Peterson1,
  2. M. Hiersche1,
  3. J. Shores1,
  4. A. Gabriel1,
  5. S. Gupta1
  1. 1Division of Plastic Surgery, Loma Linda University School of Medicine, Loma Linda, CA.

Abstract

Introduction Integra dermal matrix (Integra Life Sciences Corp., Plainsboro, NJ), introduced by Burke and Yannas in 1981, has been well established as an efficacious treatment option in the management of burn injuries. Its use has expanded beyond burn surgery to include other situations where full-thickness skin coverage is necessary. The acceptable cosmetic results commonly obtained through the use of Integra have prompted research into additional areas where minimal scarring is a priority.

Case Description A 47-year-old African American male with a large recurrent keloid of the upper chest and lower neck region underwent surgical excision of the keloid and placement of Integra without the need for subsequent skin grafting after multiple other treatment modalities had failed. At 1 year postoperatively there were no indications of keloid recurrence and the regenerated dermal tissue demonstrated smoothness, pliability, and other acceptable cosmetic features characteristic of the use of Integra.

Discussion Integra is produced as a type I collagen and chondroitin-6-sulfate matrix, which plays a significant role in reducing the inflammatory response to the wound. This prevents fibroblast activity from accelerating beyond the control of the wound repair mechanisms and in turn prevents the formation of excessive scar tissue. Immunologic studies have shown that the specific combination of collagen and chondroitin-6-sulfate results in a dampened immune response, thereby lowering the inflammatory drive. In addition, histologic studies have shown that chondroitin-6-sulfate prevents platelet aggregation and degranulation by blocking the platelet binding sites on the collagen fibers. Without this important first step in the inflammatory response the wound healing process can proceed at a self-regulating pace without the resulting hypertrophic scarring or keloid formation.

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