More clinical evidence of this life giving and saving technology.
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https://journals.lww.com/prsgo/fulltext/2023/04000/novosorb_biodegradable_temporizing_matrix_for.5.aspx
The neo-dermis has the capacity to glide over deeper structures and prevent wound contractures and hypertrophic scars.9In our experience, BTM handles better than other dermal regeneration templates and is more robust during cleaning, dressing changes, and physiotherapy. Superiority in terms of resistance to infection has also been demonstrated in in vivo studies10and has certainly been borne out in our clinical experience.
Potential disadvantages of staged reconstruction with BTM are acknowledged. There is a need for two operations, though in multiplanar degloving, a staged approach to both debridement and reconstruction can be advantageous in order to preserve as much soft tissue as possible, especially in the upper limb. Dressing changes are time-consuming and may have to be performed under general anesthesia, depending on the age of the patient. Though the simplicity of the procedure makes BTM ideally suited to resource-limited settings, its cost is likely to be prohibitive in this context at present.
As BTM is a novel product, clinical studies that include longer term follow-up are required. It will be particularly interesting to follow pediatric patients like ours and observe how reconstructed flexor surfaces progress with growth. Cost-effectiveness studies comparing staged reconstruction with BTM to single-stage, local, or free-flap reconstruction procedures are also awaited. When completing the HAND-Q patient-reported outcome measure, our patient commented that the reconstruction had “surpassed his expectations.” As with any novel treatment, the importance of including patient-reported outcomes in future work is also emphasized.
CONCLUSIONS
This case reports the successful use of BTM and split-thickness skin grafting for reconstruction of a complex multiplanar degloving injury of the upper limb. We found this approach to be particularly advantageous in the pediatric context, as it negated the need for a free-flap donor site and achieved a homogenous cosmetic result. BTM may be considered an addition to the reconstructive toolbox for management of complex multiplanar degloving injuries of the upper limb.
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