Basic techniques for optimizing burn wound healing: insights from clinical practice
Very Graphic - Beware.
Talks about various levels of burn treatment.
https://www.oaepublish.com/articles/2347-9264.2024.43Novosorb is mentioned under "optimizing outcomes of large burns"
Optimizing outcomes of large burns
The functional and cosmetic outcomes of burns are dependent on several factors. Clearly, very deep burns, especially fourth-degree burns, are more difficult to deal with. Small areas of exposed bone or tendon can often be covered with dermal substitutes, and when vascularized, they can be grafted. Areas of exposed skull can have the outer table burred to allow for granulation tissue growth and eventual grafting. Various flaps can also be used, but this paper will not cover flaps. Obviously, patients with massive burns will not have enough donor skin to use sheet grafts, so compromises must be made. The strategy of promptly removing visibly deep burns (within a few days) is important, as it helps suppress the hypermetabolic response[23]. Some of the strategies described earlier can still be used to improve outcomes in more functional or cosmetic areas. For instance, we often use sheet grafts for the hands and faces of patients with burns > 80% TBSA. The rest of the areas are covered with widely (4:1) meshed grafts. One of the problems we had in the past was the delay in re-epithelialization of the interstices of wide mesh. We have found that spraying autologous epidermal cells (RECELL®, Avita Medical, Valencia, CA) fills the interstices rapidly, and appears to accelerate the healing of the donor sites. (A more expansive description of RECELL® will be covered in another paper in this review.)
When all of the donor skin has been utilized, the remaining excised burn should be covered with a temporary “skin”. We have found that allograft does not work as well as in the past. Allograft tends to degrade after 2-3 weeks, leaving granulation tissue. A better option is to cover the wound with a dermal substitute. While we have used Integra® (Integra Life Sciences, Princeton, NJ) in the past, we currently use NovoSorb® BTM (PolyNovo North America LLC, Carlsbad, CA), which is a polyurethane foam covered with a polyurethane surface as a temporary covering. The product takes around two weeks to vascularize, but it can also develop a prolonged, quiescent state that protects the underlying tissue without signs of inflammation. As an example, it persisted without infection on the face for a patient with 90% TBSA burns for 73 days until skin was available for grafting[20]. After vascularization, NovoSorb® BTM can be grafted with sheet grafts, or wide mesh with RECELL® spray. For the burns > 85%-90% TBSA, we will also cover the matrix with 6:1 meshed autograft, cultured epithelial autografts, and RECELL®[24]. Our outcomes for the massive burn have been decent[25]. While patients survive, scarring is still a major sequela. Many other papers in this Special Issue will cover the use of the various newly available products.
Fes
(20min delay)