felix mariano, jr rcn mn pgdip clinical nurse educator

Felix Mariano, Jr RCN MN PgDip Clinical Nurse Educator Clinical Nurse Specialist

ORL Head and Neck Surgery Auckland City Hospital Auckland, New Zealand fmariano@adhb.govt.nz

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