The Boswick Burn and Wound Care Symposium was held in Maui in the last week of January.
Two abstracts describing use of BTM were presented.
Impossible Abdomens and Difficult Patients: Treatment with NovoSorb Biodegradable Temporizing Matrix (BTM) for Frozen Abdomen was presented by a physician from Arrowhead Regional Medical Center-Kaiser San Bernardino (Jan 28, 9:36 AM). It is a case study in a young adult male motor vehicle accident victim who sustained various abdominal solid and hollow organ injuries. He was left with an open abdomen and subsequently developed a frozen abdomen with liver and large area of granulated bowel in addition to an entero-atmospheric fistula.
NovoSorb Biodegradable Temporizing Matrix (BTM) applied to the granulated bowel allowed an ostomy appliance to be placed around the fistula on top of the silicone layer of the Novosorb BTM. This protected the exposed bowel and facilitated output control of the fistula with an ostomy bag. Because Novosorb BTM is resistant to infection, contamination by the fistula did not hinder eventual incorporation of the Novosorb BTM. With this approach, eventual fistula closure was achieved, and appropriate granulation tissue had formed prior to autografting. For the last few years, NovoSorb BTM has been used to treat various open wounds that span significant total body surface areas. To our knowledge, this is the first report utilizing NovoSorb BTM to aid in the closure of OA in the setting of frozen abdomen with entero-atmospheric fistula.
A Case Report of the Surgical Treatment of Severe Hidradenitis Suppurativa using NovoSorb Biodegradable Temporizing Matrix (BTM) and NovoSorb MTX Dermal Matrices was presented by a plastic surgeon at UCSF Fresno (Jan 29, 12:18 PM). It is a case study in a middle-aged male with long-term severe and extensive Hidradenitis Suppurativa. The chest was the largest impacted area, and surgical recommendations were made for a staged treatment approach.
BTM was applied along with BTM’s complementary product, Novosorb MTX. MTX was applied at the central 1/3rd of the wound to help augment the concavity present at the central portion of the wound….This case demonstrates the successful surgical treatment of a large anterior chest Hurley stage 3 HS disease using a two-stage approach with application of NovoSorb BTM and MTX dermal matrices as adjuncts. This approach avoided cumbersome postop wound care for patients and potential severe postop pain associated with dressing changes and did not require any prolonged hospitalization for treatment. Morbidity for the patient was minimize while the skin grafting outcome was maximized. This straightforward treatment approach using NovoSorb dermal matrices can potentially be applied to Hurley stage 2 or 3 disease affecting any parts of the body in Hidradenitis patients, offering curative surgery for large disease areas.Two other case studies were presented, one of which describes use of “polymer foam dermal substitute” and the other a “polymer foam dermal substrate”.
The first of these,
Atypical Presentation of Frostbite Resulting in Loss of Skin from Buttock and Bilateral Lower Extremities Without Deep Tissue Injury was presented by a Post Grad in General Surgery Residency at The Ohio State University at Wexner Medical Center (Jan 29, 5:00 PM). It is a case study of a young adult female who sustained severe and extensive frostbite injury (42% TBSA skin necrosis). The patient was found in a snowbank and unresponsive in a t-shirt and shorts during a winter storm after jumping out a moving vehicle, and sustained exposure for six hours.” Polymer foam dermal substitute” was used to optimize the wound bed for grafting from the knees down and several layers were used to cover the patella.
Conclusion: Given the extreme cold, extent of exposure and lack of protective clothing, one would have expected more extensive amputation of distal extremities. Since her feet had viable skin, muscle, and toe amputation was not required, the team put a plan into place to save the legs.The choice of employment of the omental flap was due to its neovascularization, tissue healing, and tissue regenerative properties, the application of this type of flap to the lower extremities to cover exposed tendon has only been reported one other time. We were able to create a wound bed over the exposed bone and tendon on the knees and lower legs and over the omental flap with Polymer foam dermal substitute successfully in a colonized wound bed. We were able to respect the patients need for autonomy and utilize ASCS to cover the area with limited donor sites. This case proved to be a challenging and unique presentation of frostbite; limb salvage was possible through a multimodal approach for wound coverage.The second,
Successful Treatment of Keloid/Hypertrophic Scaring after Deep Partial Thickness Burns: Utilizing Staged Excision, Synthetic Dermal Substrate, and Thin Split Thickness Autograft comes from The Ohio State University Wexner Medical Center (Jan 31, 11:27 AM). It is a case study of two patients who were offered a surgical option for symptomatic hypertrophic or keloid scaring that did not improve with laser treatment. The procedures consisted of a staged surgical approach with the initial procedure being full thickness scar excision and engraftment of “polymer foam dermal substrate.”
Conclusion: Hypertrophic and keloid scaring can be cosmetically dissatisfying, however the symptoms of nerve pain, pruritis, and scar contractures were more debilitating for these patients. These two patients are part of a subset of patients that silicone, garments, CO2 fractionated laser and/or steroid injections did not relieve symptoms. We demonstrate successful resolution of symptoms with a staged technique of scar excision and grafting with a dermal substrate. In the case of scar excision, the dermal substrate is incorporated in 2 weeks and ready for grafting. In addition to resolution of symptoms, there was no return of abnormal scaring in follow up from 6 months to 2 years.View attachment 5960800
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