I understand there are a number here interested in these more detailed excerpts so I looked into the Journal listed above; here's the following entries. Some very interesting off-label uses being carried out here. Most of note is its effectiveness when being applied to wounds with current underlying infections and co-morbidities with good outcomes regularly reported. Enjoy some light Saturday night reading folks.
BIODEGRADABLE TEMPORIZING MATRIX – EXPLORING ITS DIVERSITY OF APPLICATIONS
Henry Li , Edward Stanley, Geoffrey Lee, Sandra Lin and Sally NgAustin Health, VIC
Purpose: The NovoSorbTM (PolyNovo Ltd, Melbourne, Australia) Biodegradable Temporizing Matrix (BTM) is a synthetic dermal matrix used to reconstruct dermal wounds while retaining the natural thickness of skin, preventing contraction and resisting infection. It is mainly used in major burns, necrotising fasciitis and free flap donor wounds [1] however has the potential to provide favourable outcomes in a wider scope of practice.
Methodology : Consecutive patients who had BTM application and subsequent skin grafting by the plastic surgery unit across three tertiary centres in a 15 month period were included. Patients were followed up in outpatient clinics for 3 to 18 months, assessing graft take and complications.
Results: 11 cases were identified with aetiologies including two delayed reconstructions post scalp lesion excision, two free flap donor sites, two post‐operative wound dehiscences, one necrotising fasciitis with exposed tendon after failed skin graft, one calcaneal osteomyelitis, one pressure sore, one re‐excision of a pre‐auricular skin lesion and one arthrodesis wound with exposed metalware. Four cases had partial graft loss that later healed by secondary intention and all cases experienced successful reconstructions of their wounds.
Conclusion: The ease of application, minimal complications and good cosmetic outcomes of BTM have led to effective reconstructions in new scenarios, though cost remains a concern. Further clinical applications should be studied in the future in larger scale.
Reference1. Wagstaff, M.J., I.M. Salna, Y. Caplash, et al ., Biodegradable Temporizing Matrix (BTM) for the reconstruction of defects following serial debridement for necrotising fasciitis: A case series. Burns Open , 2019. 3(1): p12‐30
APPLICATION OF BIODEGRADABLE TEMPORIZING MATRIX IN MANAGEMENT OF PYODERMA GANGRENOSUM ULCER
Ines Prasidha , Anthony Barker, Robert Knight and Peter Haertsch
Wollongong Hospital, NSW
Pyoderma gangrenosum is a rare condition, of unknown aetiology, that presents as painful ulceration with inflammation. Pathergy is seen in this condition and the mainstay of treatment is immunosuppression, however surgery sometimes plays a role in the reconstruction of the wound. Recently, dermal matrices are becoming more available however, its use in inflammatory wounds is infrequent. We herein report the first case of application of Biodegradable Temporizing Matrix (BTM), a synthetic, biodegradable, polyurethane foam matrix, in pyoderma gangrenosum of the leg.
A 71 years old female with pyoderma gangrenosum, whom comorbidities include rheumatoid arthritis and type 2 diabetes, presented with a 15 × 10 cm wound on her left anterolateral leg with exposed tibialis anterior, peroneus longus, and peroneus brevis tendons. She has received treatment with prednisone, adalimumab and diprosone cream in the past year, however the disease continues to progress. Her presentation was complicated by wound infection with Staphylococcus aureus and Pseudomonas aeruginosa. Along with aggressive immunosuppression therapy, antibiotic treatment, and optimisation of her comorbidities, she underwent surgical debridement, application of BTM, and skin grafting with a good outcome.
Surgery can play an important role in the reconstruction of pyoderma gangrenosum wound and the application of dermal matrix can provide pain relief and wound coverage, with an acceptable aesthetic outcome.
References1. Climov M, Bayer LR, Moscoso AV, et al . The role of dermal matrices in treating inflammatory and diabetic wounds. Plast Reconstr Surg . 2016; 138(3S):148S – 157, S.2. Pompeo, MQ, Pyoderma gangrenosum: recognition and management. Wounds 2016; 28(1):7‐13.
BIODEGRADABLE TEMPORIZING MATRIX (BTM) APPLICATION IN LOWER LIMB SALVAGE
Kartik Iyer , Jeon Cha and Bishoy Soliman
Royal North Shore Hospital, NSW
Introduction: Lower limb reconstruction is often required in the setting of trauma, cancer and infection. The primary objective is to restore or maintain pre‐morbid function. Currently, reconstruction with free autologous tissue remains the best choice. This may not be possible due to patient age, comorbidities, availability of donor sites/recipient vessels and patient preference. To date, BTM has been demonstrated as a useful reconstructive tool in complex burn, free flap donor site and diabetic/necrotising fasciitis wound management1‐5. There is limited data on its use in lower limb reconstruction.
We present a case of a 76‐year‐old male, with a trimalleolar fracture of the left lower limb, who developed necrotic malleolar wounds post fixation. Due to patient comorbidities and significant peripheral vascular disease not amenable to conventional reconstructive options, a two stage reconstruction with BTM and skin grafting was attempted.
Methods: Following serial debridement and removal of infected metal work, BTM was templated and inset directly over the bony defects. After 6 weeks of VAC therapy, the BTM had adequately integrated, and was subsequently delaminated and grafted.
Results: This procedure resulted in successful integration and 100% graft take. Furthermore, there was good contour restoration with robust coverage of the underlying bony defect noted at subsequent follow up.
Conclusion: This case highlights the ability of BTM to integrate and bridge bony defects with good aesthetic and functional outcomes. Thus this two‐stage procedure provides reconstructive surgeons with an alternative technique in patients with significant comorbidities and poor underlying vasculature unsuitable for free flap reconstruction.
BIODEGRADABLE TEMPORIZING MATRIX FOR ORBITAL EXENTERATION RECONSTRUCTION
Sarah Anthony , Sarah Lonie, Michael Thomson and Mikko Larsen
Launceston General Hospital, TAS
Purpose: Orbital exenteration is the removal of the eyeball and orbital contents. Several methods are available for reconstructing the defect; ranging from healing by secondary intention, local temporalis muscle flap and microsurgical reconstruction.Methods: We describe the technique of using biodegradable temporizing matrix (BTM) for reconstruction of orbital defects rather than local muscle flaps.
Results: We present a case report of an 82 year old man with right upper and lower eyelid and bulbar conjunctival sebaceous carcinoma requiring primary resection including extended orbital exenteration. He was managed with BTM inset on the day of resection then delamination and split thickness skin graft 4 weeks later. On latest review 2 months post‐operatively, his orbital defect has completely healed with good aesthetic result.
Conclusion: The use of BTM offers a shorter operation, smaller donor site and good aesthetic outcome for patients with a quick recovery. This is particularly a beneficial procedure in medically co‐morbid patients.
NECROTISING FASCIITIS RECONSTRUCTION USING BIODEGRADABLE TEMPORIZING MATRIX (BTM): CHANGING THE ART OF GRAFTING
Eugenia Koulaeva , Bejamin Howes, Krishna Rao and Alexandra Turner
The Canberra Hospital, ACT
Purpose: To describe the use of BTM for reconstruction of a defect in the setting of a necrotising infection following an insect bite. The use of BTM for this indication is novel and has only recently been reported in the literature.
Methodology: A 39‐year‐old female patient underwent serial debridement of the dorsum of her right foot in the setting of necrotising fasciitis. The defect had a total body surface area of 1.5%, located over the dorsum of the foot and involving the antero‐lateral aspect of the ankle. Given the substantial area involved, location and underlying infection, consideration was made for the use of BTM. A literature review of BTM in this patient group was undertaken. Once the wound bed was clean, BTM was inset. The defect was grafted 6 weeks after BTM application.
Results: There have been few papers which document the use of BTM in the setting of infection or post necrotising fasciitis. However, the few papers that do describe the use of BTM in complex acute wounds and defects following serial debridement suggest that this synthetic dermal substitute has the ability to resist infection and integrate into large wound beds.Post‐operative follow‐up of this patient demonstrated 100% graft take, with uniformity of texture, good contour and no evidence of scar contracture.
Conclusion: BTM is a suitable choice for reconstruction of complex soft tissue defects in the setting of necrotising fasciitis or severe infection.
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