Infectious Complications Associated with the Use of Integra: A Systematic Review of the Literature

BACKGROUND:Dermal regeneration templates such as Integra are effective reconstructive biomaterials used in a variety of soft-tissue defects. Fully understanding the complications associated with their use is paramount to improve outcomes and maximize patient safety. In this study, our purpose is to perform a comprehensive literature review to assess the previously reported infectious complications linked to Integra-based wound closure. METHODS:We conducted a systematic review of the literature to identify previous articles indexed in PubMed and Ovid for Integra and its synonymous terms. We used these search terms[Integra OR (dermal regenerative matrix) OR (dermal regeneration matrix) OR (dermal regenerative template) OR (dermal regeneration template) OR (dermal substitute) OR (skin substitute) OR (artificial skin)] AND infection. RESULTS:Of the 3508 articles for initial review, 69 reported rates of infection, of which 26 reported ≥1 infection within their cohort. Of these 26 articles, the patients (n = 602) underwent Integra-based reconstruction in 1254 sites and had reported infections in 212 of the sites (16.9%). Among these, we encountered a single report of a fatal case of toxic shock syndrome (TSS) related to the use of Integra in secondary burn reconstruction. CONCLUSIONS:While Integra offers many benefits, surgeons must be aware that infectious complications are not uncommon. As a result, a careful risk–benefit analysis of its use in reconstruction must be performed, and open discussion with the patient preoperatively regarding infection rate is of utmost importance.