PNV Media Thread, page-753

Biggest takeaways from this one. 5 Infections did occur, none of which were associated with the BTM itself but rather the initial wound flora (bacteria), however 4 of these were able to salvage 100% of the BTM and continue with wound integration, something which our biological counterparts do not have the luxury of. I've attached the most interesting points below.

In all cases of infection, these occurred within two weeks of application of BTM, and allpatients had wounds on the hand or foot region resulting from infection or trauma. Themicroorganisms isolated from infected wounds were diverse (Table 1.). In four of thesecases, by managing the patient as described above, 100% of the BTM was able to besalvaged and went on to integrate, establishing a neodermis that allowed the second stageskin graft to proceed as normal. The one case that failed was a patient being managed in thecommunity where the infection was not detected early enough and the BTM could not besalvaged. In this case the entire material was removed and the wound left to heal bysecondary intention.

In contrastto other dermal matrices where infection often leads to failure of the material, earlyinfection was able to be successfully treated and the BTM salvaged with a combination of topical wound care and antibiotics. This included one patient who was being treated for aninfected diabetic foot ulcer which was thought to be at high risk for failure. Themicrobiology present in infection was reflective of initial wound flora. No specific pattern ofinfection was identified in association with BTM use

The main contraindication we found for using BTM was in areas that were poorlyvascularised, such as the foot and ankle region in patients with peripheral vascular disease.We now recommend caution in using BTM in these areas as they are at high risk of failure.

We found BTM to be a versatile reconstructive option that can be applied successfully to awide range of defects. In the majority of cases the early outcomes were excellent withregards to thickness and pliability of the integument. For optimal outcomes BTM requirescareful case selection, close follow up and meticulous wound care, similar to other dermaltemplates. Although the overall complication rate is high, BTM proved surprisingly resilient,particularly in infection, demonstrating a high salvage rate which did not detrimentallyaffect neodermal formation or subsequent successful skin graft take.

Conclusions: BTM provided a good reconstructive option for a wide range of defects, manyof which were not amenable to immediate skin grafting. Once vascularised and ready forthe second stage, it developed a red-pink colour and demonstrated capillary refill. Similar toother dermal matrices, infection was a commonly encountered problem. However, BTMproved more tolerant to this and was able to be salvaged in most cases, allowing the secondstage to proceed as normal.