Schiestl et al. (2021) - Expanding into the future: Combining a...

Schiestl et al. (2021) - Expanding into the future: Combining a novel dermal template with distinct variants of autologous cultured skin substitutes in massive burns.

Our colleagues in Switzerland have released their results from their first ever experience with BTM on the same day the approval went through. Extract from point 3.1 in the article attached. I've bolded the key points from this.

https://www.sciencedirect.com/science/article/pii/S2468912221000213

Early burn wound excision and temporary coverage was completed by PAD. Initial allografts were exchanged for NovoSorb® BTM dermal template for longer-lasting and supportive coverage. On PAD 25, nearly 60% of the TBSA was covered with NovoSorb® BTM and the remaining 35% with either allografts or with the first harvest of STSGs.

NovoSorb® BTM is a novel biodegradable polymer for intermediate wound coverage that leads to the generation of a stable neodermis within approximately three weeks [12]. It showed a rapid integration with no adverse effects. Aside from its impressive mechanical stability, which allowed us to regularly bathe and scrub the NovoSorb® BTM areas as well as to mobilise the patient, we argue that it supported the overall stabilisation of our patient by minimising fluid loss and by serving as a protective layer against bacterial contamination. In fact, we did not see any significant infection of NovoSorb® BTM, a complication well-known when applying other dermal substitutes [13], [14]. NovoSorb® BTM led to a well vascularised neodermis which enabled definitive coverage using various autologous skin products. Leaving NovoSorb® BTM on the patient for several weeks (maximum of 17 weeks on the back) did not impact graft adherence. All bio-engineered autologous skin substitutes showed excellent take rates on NovoSorb® BTM.

As NovoSorb® BTM is a novel product, there is a general paucity of literature describing relevant outcomes. However, recent publications support our findings, showing excellent results after combining NovoSorb® BTM with autologous skin substitutes and cell suspensions [15], [16], [17], [18]. Of note, anatomic regions where NovoSorb® BTM was applied did not require any secondary reconstructive surgery thus far. A number of studies using animal models have noted reduced shrinkage of autologous grafts on Novosorb® BTM [11], [19], [20], however only long-term studies can definitively address this important aspect.

Current standard methods for temporary coverage of large burn wounds include allografts, which are readily available at our institution. Main disadvantages include the necessity of repeat replacement with associated surgical morbidity, blood loss as well as cumulative cost. In contrast, and advantageously, Novosorb® BTM, a synthetic off the shelf product, comes in various sizes and does not require replacement. Moreover, Novosorb® BTM can also be applied immediately onto the excised burn wound. As Novosorb® BTM only became available in Switzerland on the actual day of the patient‘s injury, our team lacked any prior experience with this product. We therefore decided to first cover the excised areas with allografts and then exchange them with Novosorb® BTM. Direct application, as described by Greenwood [16], [17], would presumably be more time efficient and cost-effective.