The chronic wide wound with healthy granulation tissue can be managed with ‘tincture of time’ and will eventually close.
Another option (absent infection or recurrence) is to apply Integra over the site and place a bolster over the Integra.
- Soak the Integra for one minute in NS after cutting it to size
- Place the Integra over the granulation tissue, with the shiny (silicone) side up. This side has black lines on it.
- Do NOT slide the Integra into place – lift it off and replace it
- Suture the edges of the Integra to the edge of the wound with running Chromic suture
- Pie-crust the Integra slightly
- Silk loops are placed in the skin around the site (2-0 or #0 Silk). This provides an anchor to attach the suture over the bolster.
- Place non-stick material over the Integra, and the bolster over the non-stick material
- Use PDS or other material looped thru the silk anchors to tie the bolster securely down over the wound
- Return to clinic weekly for dressing change (leave the Integra and just change the bolster)
Sizes of Integra available:
2 in x 2 in (25 sq cm)
4 in x 5 in (125 sq cm)
4 in x 10 in (250 sq cm)
8 in x 10 in (500 sq cm)