Cath Lab Digest

Skin is an important body component that performs many critical functions. First in the line of defense for the immune system, skin helps protect the body from invasion by potentially dangerous substances.¹ Body temperature regulation is aided by the skin's ability to excrete moisture and radiate or conduct heat as needed.² In addition, the skin represents the body's most extensive sense organ for receiving tactile, thermal, and painful stimuli.³

Preterm infants are born with organ systems that have not had an opportunity to develop completely. These underdeveloped organ systems are unable to perform physiologically as well as those of their full-term counterparts. Infants of less than 24-weeks gestation are born with transparent, friable skin that is unable to provide the full range of protective functions intrinsic to fully mature skin. Moreover, the skin of preterm infants is more easily damaged because of the relative thinness of the three skin layers (epidermis, dermis, and subcutaneous fat), limited attachment points of the epidermis to the dermis, and immature production of lipids.⁴ These deficiencies of the skin’s integrity leave the preterm neonate vulnerable to infectious complications and to disorders involving fluid and electrolyte homeostasis. As a result of these complications, the likelihood of skin breakdown may be increased and wound healing may be impaired.

Interventions in caring for the skin of preterm infants are directed toward minimizing trauma and preventing fluid loss. Application of topical emollients reduces transepidermal water loss and serves as a barrier to irritation.⁴ Lamb's wool, silicone gel mattresses, and various other support devices are used to relieve pressure as much as possible to prevent the development of decubitus ulcers.⁵ When ulcers develop, treatment usually is focused on providing meticulous wound care in an effort to control the local wound environment and prevent infection. In most cases, these wounds are allowed to heal by secondary intention. The following case report describes the use of bilayered cellular matrix (BCM) (OrCel™, Ortec International, Inc., New York, NY), to expedite healing of a skin wound in a preterm infant.

Case History

A 2-day-old male neonate born 17 weeks prematurely at 23 weeks gestation was transferred to the authors' neonatal intensive care unit (NICU). The infant weighed 500 grams at the time of NICU admission. He had a denuded left hip wound (see Figure 1) measuring 2.0 cm x 1.5 cm. He also had a small skin tear involving the right axilla. No signs of fluid or electrolyte disturbances were noted. The NICU consulted the Burn and Wound Center, which obtained BCM. Use was on a per patient emergency basis.

Applying BCM involves opening the cassette containing the product and removing the nonadherent backing protecting the fibroblasts. The product is lifted out of the cassette with two noncrushing sterile forceps and draped over the wound bed with the backing protecting the keratinocytes oriented superiorly (see Figure 2). Bilayered cellular matrix conforms easily to the wound. The product is not fragile and maintains structural integrity upon placement on the wound. The porosity of the product allows for fluid absorption and for excess wound fluid passage to the outer dressing. This prevents the BCM from lifting off the wound bed.