Integra					Subjects
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For thorough information about Integra, see these resources: #01 - This gives the most comprehensive information on the use of Integra. Full text and images. #02 - Original research detailing the use of Integra for chronic and pathological wounds. Full text and images. #04 - This discusses Integra biology in detail. Full text and images. #03 - Annotated case studies. Full text and images. These links discuss the roles of Integra versus conventional surgery: #05 - A simple self-annotated poster presentation discussing how and why Integra is supplanting more conventional operations, with less risk and better results. Abbreviated text. #06 - Further presentation of wound surgery and Integra biology. Not annotated. #08 - A discussion of wound surgery in general, including the important new role of Integra. Full text and images. #09 - More case studies, question and answer tutorial. Full text and images. #10 - Integra for the reconstruction of complex hand and upper extremity wounds. Pending post. These links relate to special Integra topics: #07a - A 2003 presentation to CMS, discussing the clinical use and demographics of Integra in the Medicare population. Full text and images. #07b - Another presentation to CMS, December 2005, explaining Integra’s use and efficiencies for Medicare patients. Not annotated. #11 - Integra for the reconstruction of lymphedema. Pending post.
INTEGRA		Integra is an “artificial skin” originally developed for burn management. Released to market in 1996, it is an extraordinary unique product that has proven itself for the management of various acute injuries, elective skin and soft tissue reconstructions, and the management of chronic wounds. It is manufactured and distributed by Integra Life Sciences, Plainsboro, New Jersey. Visit their site for the manufacturer’s information on this product. Below are the Arimedica resources on this product (greyed entries are not yet, but soon to be on line).
#01 Integra: general principles, & chronic wounds		Management of Complex and Pathological Wounds with Integra, by Marc E. Gottlieb. Published in part in: Lee BY, ed. The Wound Management Manual. New York, McGraw-Hill, 2004: 226-289. (ISBN 0-07-143203-5). This Arimedica version has expanded content and case studies. Read this paper for an exhaustive discussion of Integra usage, with the focus on chronic wounds, but also addressing acute and reconstructive indications. It includes a discussion of Integra biology and histogenesis, a large gallery of cases, and a bibliography. Images and text. Online: HTML (8.5 MB)
#02 Integra: chronic wounds		Successful Management and Surgical Closure of Chronic and Pathological Wounds Using Integra®, by Marc E. Gottlieb, Jennifer Furman. Journal of Burns and Wounds, vol03, #02, 2004. This paper documents the experience with Integra for chronic wounds. Read this for detailed data concerning outcomes, as well as general “how-to” information for using Integra on chronic wounds. Images, tables, text. Online: HTML (7 MB), or . . . Original source @ Journal of Burns and Wounds: PDF (3.4 MB).
#03 Integra: case studies		Managing Complex and Pathological Wounds with Integra® - A Gallery of Cases, by Marc E. Gottlieb. Here is a collection of nearly 70 cases, illustrating the use of Integra, with the emphasis on chronic and pathological wounds. Images and text. Online: HTML (3.3 MB) PDF (2.1 MB)
#04 Integra: histogenesis		Histogenesis versus Wound Repair: the Anatomy of Integra’s Properties, by Marc E. Gottlieb. Originally presented at The Boswick Burn and Wound Meeting, Maui, February, 2003. Subsequent presentations, 2003-2005. Integra regeneration is distinctly different than normal wound healing. It is highly analogous to normal embryonic histogenesis, and these differences explain the desirable properties of the material and its biological effects. This paper presents detailed comparisons of the histology and dynamics of normal inflammatory wound repair versus Integra histogenesis. Slides and text. Online: HTML (26 MB) PDF (16 MB)
#05 Integra: in situ tissue engineering		In situ Tissue Engineering with Integra®, by Marc E. Gottlieb. Originally prepared and presented in Chicago, May, 2005. Because Integra regeneration is distinctly different than normal wound healing, it has properties which allow it to close wounds which fail any other form of surgery (which ordinarily depends on normal wound healing). This makes it ideally suited to high risk wounds. It is a distinct new paradigm of surgery – in situ tissue engineering. Abbreviated text and illustrations. Online: PDF (770 KB)
#06 Integra: fourth paradigm of surgery		In Situ Tissue Engineering with Integra - A New Paradigm of Surgical Wound Repair, by Marc E. Gottlieb. Originally presented in Orlando, August, 2005. This presentation expands on the role of Integra as a distinct new paradigm of surgery. It includes a review of Integra histogenesis histology. Slide presentation format. No annotations – check back later for updated version. Online: PDF (6.1 MB)
#07a Integra: geriatric problems		Integra and the Medicare Patient, by Marc E. Gottlieb. Originally presented in Bethesda, MD, July, 2003. This presentation focuses on Integra’s role in managing complex and pathological wounds in elder patients. Fully annotated. Online: HTML (20.3 MB) PDF (11.3 MB)
#07b Integra: geriatric problems		Integra Artificial Skin - Understanding its Extraordinary Clinical Results and Economic Efficiencies, by Marc E. Gottlieb. Bethesda, MD, December 14, 2005. This presentation focuses on Integra’s role in managing complex and pathological wounds in elder patients, with a focus on why it is suited to outpatient use. Not yet annotated. Online: PDF (13.4 MB)
#08 Integra: podiatry problems		Closing the Foot - Repair, Reconstruction, and Plastic Surgery of the Lower Extremity, by Marc E. Gottlieb. Originally presented in Boston, August 23, 2004, for the American Podiatric Medical Association (APMA). This presentation discusses the general principles of wound closure surgery, with an emphasis on the foot and lower extremity. It includes a conspectus of basic plastic surgical principles, and a discussion of Integra and other new wound technologies. Online: Slides only, no annotations, PDF (18 MB) Annotated, PDF (5.1 MB)
#09 Integra: podiatry questions & tutorial		Case studies. A companion to the above APMA presentation. These fully commented cases are a tutorial on the basic principles of wound closure and plastic surgery, culminating in cases that illustrate how Integra can succeed when other options cannot. Online: PDF (1.1 MB)
#10 Integra: complex hand cover & reconstruction		Will be posted soon.
#11 Integra: lymphedema mgmt & reconstruction		Lower Extremity Lymphedema – Management by Total Dermatofasciectomy and Skin Reconstruction with Integra. Marc E. Gottlieb. Originally presented at Boswick Burn and Wound Symposium, Maui, February 2003. This presentation has slides only, plus an abstract, but no slide-by-slide annotation. It presents basic general concepts about lymphedema and its management, and then focuses on the reconstruction and rehabilitation of patients with crippling primary lymphedema using Integra. Online: PDF (9.5 MB)
#12 Integra: necrotizing fasciitis		Surgical Treatment and Reconstruction of Necrotizing Soft Tissue Infections. Marc E. Gottlieb. Originally presented at Squaw Valley, CA, August 12, 2006, for the MSIS – Musculoskeletal Infection Society, 16th Annual Meeting. This presentation is about necrotizing infections and their surgical management. It includes a conspectus of basic plastic surgical principles, with a discussion of Integra and other new wound technologies that have improved the care of fasciitis. Online: Slide version (PPT 4MB). Complete, with text annotations. Powerpoint web presentation (HTML 4MB). Complete, with text annotations. Reader’s format (HTML 18MB). Complete, with text annotations. Slides & text (PDF 5.4MB). Complete, with text annotations.
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