PNV (ASX) PNV Media Thread

Originally posted by jkg93 ↑

Good evening gents, thanks for posting that article Hottod. I'll attach the full-text PDF below.

The biggest take aways from this are that both patients with >90%TBSA burns survived and Novosorb BTM played a noticeable role in improving metabolic control, limiting systemic inflammatory response syndrome and fluid loss, both of which are two massive drivers behind burn mortality. This is something which we have not yet considered, but something which has massive upside as a treatment protocol. It should also be noted that Novosorb was only removed in order for aggressive debridement to occur to treat the significant underlying infection to prevent sepsis.

Here are my favourite snippets from the case series.

Recent advancements in specialized care provided at burn facilities have helped to improve the mortality rate of patients with 50–90% TBSA burns. Patients with FT burns, however, continue to pose challenges and difficulties related to dealing with exposed fascia, muscle, and tendons . In this case series, we utilized a multi-step process which included using allograft, NovoSorb BTM as the primary dermal substitute, and RECELL withSTSG in place of cultured epidermal autograft to achieve coverage of >90%burns with high meshed ratio. Early in the resuscitation phase, controlling systemic inflammatory response syndrome(SIRS) with debridement of necrotic burns and early wound coverage is critical. For both patients, this was achieved by leveraging early debridement and allograft and NovoSorb BTM placement. Based on these two cases, NovoSorb BTM shows potential as an equally effective, if not more effective, resource for controlling wound fluid loss and earlier resolution ofSIRS. This was especially evident with Patient 2, whose burns were primarily of the 3rd and 4th degree. With this patient, the team utilized NovoSorb BTM early in the treatment process with noticeable improvement in fluid loss seen on the dressing and reduction in fluid requirements.
While Integra, a bi-layered dermal substitute, is considered to be the gold standard among dermal substitutes, complications proved to be limiting due to infection was not removed. Any areas that showed signs of infection were trimmed or unroofed and allowed to drain. For Patient1, however, we did not feel comfortable leaving the NovoSorb BTM over the surface where visible Mucormycosis fungal involvement was noted with underlying necrosis. While it is unclear whether leaving the partially-adhered NovoSorb BTM on Patient 1 Mucormycosis on the back and flank would have been possible, it is likely that the necrosis caused by Mucormycosis could have led to severe sepsis if not treated with aggressive debridement. Outside of the Mucormyosis, the non-excised infected areas eventually incorporated the synthetic dermis and allowed autologous grafting.
With infection, NovoSorb BTM contractures. Post reconstruction, areas covered withNovoSorb BTM exhibited less hypertrophy and contracture bands. The elbow and knee joints showed minimal restriction with passive motion and good skin compliance, but the patient still experienced significant limitations related to active motion, likely due to tendon contracture from the severity of the burns. Our experience with NovoSorb BTM is similar to the use of other dermal substitutes, which offered enhanced healing of the wound bed, favorable cosmetic outcomes, and improved functionality . Functional improvement was demonstrated with early use of NovoSorb BTM on the entire face of Patient 1which prevented the need for tracheostomy. Where on Patient 2, the face was treated later due to hemodynamic instability and delays in consent resulting in oral contractures requiring tracheostomy.
Additionally, the benefits of limiting fluid loss from the use of NovoSorb BTM cannot be understated.Once allograft and NovoSorb BTM was placed, the improvement in SIRS and fluid loss was clinically significant especially on patient 2 where large surface areas were covered with NovoSorb BTM (Figure 1E). Gauze dressing were no longer soaked and the fluid replacement requirements decreased. More allograft failed early resulting in lifting and fluid loss than NovoSorb BTM prior to auto grafting. The synthetic bilayer was able to control fluid loss better through the entire length of time from excision to final autograft than allograft.

Malkoc et al 2020.pdf

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Well mucormycosis is a potentially deadly infection that usually only appears in immune compromised patients, and I'm pretty sure the right thing to do is aggressive debridement. Clearly it worked. It would be very risky to leave it and hope.

I'm not so sure that "delays in consent" should be an obstacle to treatment in life threatening burns where the patient actually suffered permanent harm as the result. Usually there's a legal mechanism that allows physicians to institute treatments where significant harm would result from a treatment being withheld or delayed. But perhaps lack of familiarity with using BTM was also a factor, so they didn't appreciate it might have made such a big difference. Just IMO though... we live and learn and both patients survived.

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