Does it stack up? Stacked biodegradable temporising matrix for contracture release of the foot: a case report

NovoSorb® (PolyNovo Biomaterials Pty Ltd, 2/320 Lorimer Street, Port Melbourne, Victoria, 3207, Australia) biodegradable temporising matrix (BTM) is a synthetic dermal substitute that has provided an alternate approach to dermal loss and reconstruction to the classical reconstructive ladder. Biodegradable temporising matrix is designed to be used in a two-stage process in conjunction with skin grafting and provides an intermediate step where the wound bed is improved prior to definitive grafting.^1^ To date, there are few cases that have documented secondary intention healing over BTM and these have involved small areas in physiologically well individuals. This case represents the largest area of healing via secondary intention over BTM we are aware of in the literature, which resulted from continued deferment of the secondary grafting procedures due to the patient’s fluctuating acute medical status.

Timing of delamination of biodegradable temporizing matrix prior to cultured epidermal autografting in burn reconstruction: A case report with literature review

Excision of a large trichilemmal carcinoma of the back with staged reconstruction using biodegradable temporizing matrix (BTM): A case report

Introduction In a large adult and pediatric metropolitan burn center, we are faced with a variety of challenging burn and complex wound cases that require surgical intervention. With the introduction of a new biodegradable temporizing matrix (BTM) in the US in 2017, we have introduced into our surgical routine a new option for wound coverage in these complex cases. This new biodegradable temporizing matrix has allowed us to provide dermal support and temporary wound closure in critical patients undergoing life-saving clinical support while awaiting skin graft closure. We share our experience using BTM in managing complex wounds in a series of patients over the past year. Methods A retrospective chart review of six patients who were admitted to our burn center, underwent BTM placement and subsequent skin grafting from February 2018 – August 2019 was performed. We analyzed mechanism and type of injury, indication for BTM placement, post burn day (PBD) placement of BTM and PBD to skin grafting and objective patient outcome. Results Conclusions: The availability of a biodegradable temporizing, polyurethane-based material in our burn center has positively added to our repertoire as surgeons an additional method for temporary wound closure as a dermal template. What we have learned is that we can improve wound bed preparation for ultimate skin grafting, particularly in critically ill patients with complex wounds and comorbidities. Applicability of Research to Practice Directly applicable to research.

IntroductionComplex diabetes-related foot wounds are at high risk of infection and subsequent major amputation unless healed expediently. Biodegradable Temporising Matrix (BTM) is a synthetic matrix that facilitates the organisation of the extracellular matrix, resulting in a neodermis layer over these difficult-to-heal areas. The aim of this study was to evaluate the efficacy of using BTM in the reconstruction of challenging diabetic foot wounds.MethodsEighteen patients with complex diabetic foot wounds (exposed tendon, fascia, joint, bone), or chronic ulcers at high shear stress locations had BTM applied. Indications for BTM application were high shear stress location (66.6%), exposed bone (16.6%), exposed fascia (5.6%), exposed tendon (5.6%) and chronic non-healing wound (5.6%). The time to complete healing, infection rate and incidence of subsequent wound breakdown was analysed.DiscussionThirteen of 18 patients completed the BTM treatment regime with all these patients achieving complete wound healing at a median time of 13 weeks. One patient had partial treatment with BTM and four patients were withdrawn from the study following BTM application. The rate of infection and re-ulceration were both 15.4%.ConclusionThis is the first prospective cohort pilot study evaluating the use of BTM for complex diabetic foot wounds. BTM demonstrates potential in healing uninfected, non-ischaemic diabetic foot wounds with exposed deep structures and chronic wounds subject to high shear stress. The re-ulceration and infection rates were relatively low for this high-risk population. BTM may also offer promise as an alternative to free flaps.Lay SummaryThe prevalence of diabetes and its complications, including foot ulcers and wounds, have significantly increased worldwide over the last 40 years. Increasingly patients are admitted to hospital for antibiotics, debridements and subsequent amputations from these wounds. Complex diabetes-associated wounds are those at highest risk of these complications or necessitating more extensive, complex operations such as free flaps. These wounds may have exposed deep structures, be at risk of high shear stress or be chronic non-healing wounds.Temporisers are a type of material which integrates into the wound and promotes in-growth of tissue, ideal for healing over these difficult to heal areas. Biodegradable Temporising Matrix (BTM) is a synthetic temporising matrix which has demonstrated positive outcomes in facilitating healing in burns and plastics wounds, but its effectiveness in diabetic foot wounds has not yet been proven. This is the first prospective cohort pilot study evaluating the use of BTM for complex diabetic foot wounds. BTM demonstrates potential in healing uninfected, non-ischaemic complex diabetic foot wounds and potentially avoiding more complex operations.

Case report: The use of biodegradable temporising matrix in breast reconstruction following flame burn to chest

Rhinophyma, a severe form of rosacea, causes significant nasal disfigurement, posing challenges for aesthetic reconstruction after excision. This case report details the novel application of PolyNovo’s NovoSorb® biodegradable temporizing matrix (BTM), a synthetic dermal substitute, for aesthetic nasal reconstruction following rhinophyma excision and utilizing secondary intention healing. A 65-year-old male with progressive rhinophyma underwent tangential excision and burring. A tailored piece of NovoSorb® BTM was applied and secured to the defect. Postoperative care involved paraffin gauze. The patient exhibited excellent aesthetic results with minimal scarring. Outcome measures, including the FACE-Q Skin Cancer Module and the Dermatology Life Quality Index (DLQI), demonstrated significant improvements in appearance-related concerns, psychosocial well-being, and daily functioning. This report highlights the innovative use of NovoSorb® BTM and secondary intention healing for rhinophyma reconstruction. The successful outcome, supported by validated patient-reported outcome measures, suggests that BTM may be a valuable tool in similar cases, offering a new avenue for achieving both functional and aesthetic goals.

Introduction: We recently published a 10-patient case series where free flap donor site reconstruction was performed as a 2-stage procedure using an integrating biodegradable polyurethane matrix (to form a neodermis), followed by definitive closure with an autologous split-skin graft. Two issues were revealed by this pilot study that led to further modification of the biodegradable temporizing matrix. This involved alterations to the seal thickness and bonding to the foam matrix and the introduction of fenestrations to the seal. Objective: This article documents a second cohort of patients requiring free flap (fibular and radial forearm) donor site reconstruction with this optimized material. Methods: The biodegradable temporizing matrix was implanted when the free flap was detached from its donor site. Subsequent integration was monitored closely. Five weeks was the usual time of integration before delamination (seal removal), dermabrasion, and definitive closure with autograft. Results: Integration was complete and uncomplicated in every case, delamination occurred in 1 piece in 1 action, and subsequent graft take was 100% for every patient. Long-term scar outcomes improved compared with the pilot group. Degradation is complete by 12 months, other than occasional microscopic remnants undergoing phagocytosis. Conclusion: This study has reiterated that the biodegradable temporizing matrix can be implanted into humans, followed by neovascularization and integration. No infection was observed, and split-skin overgrafting was successful and uncomplicated.

Necrotising soft tissue infection (NSTI) is a rapidly progressing disease that presents a surgical emergency. Timely antibiotics, radical debridement of infected tissues and adjuvant hyperbaric oxygen therapy are the foundations of its treatment. Split-skin graft (SSG) is the main reconstruction technique due to its simplicity and dependability. Dermal substitutes, as well as creating a suitable wound bed for grafting, aim to recreate the inherent thickness and pliability of skin. One innovation, Novosorb™ (produced by PolyNovo Ltd, Port Melbourne, Australia), is a biodegradable temporising matrix (BTM) that is an entirely synthetic implantable dermal matrix that creates a neo-dermis in complex wounds.

We have developed a biodegradable temporizing matrix (BTM) capable of supporting secondary split-skin graft-take in animal studies. We report its first long-term implantation and use as a dermal scaffold in humans. This preliminary study assesses its ability to integrate, its ease of delamination, its ability to sustain split-skin graft in complex wounds, the degree of wound contraction, and ultimately the quality of the scar at 1 year postimplantation. Ten patients were recruited, each requiring elective free flap reconstruction. Free flap donor sites created were anterolateral thigh flaps, fibular osseocutaneous flaps, or radial/ulnar forearm (RF/UF) flaps. The BTM was implanted when the flap was detached from its donor site. Dressing changes were performed twice weekly. The time elapsed between implantation and delamination depended on the type of flap and thus the wound bed left. Once integrated, the BTMs were delaminated in theatre, and the surface of the “neodermis” was refreshed by dermabrasion, prior to application of a split-skin graft. The BTM integration occurred in all patients (100% in 6 patients, with 90%, 84%, 76%, and 60% integration in the remainder). Integrated BTM sustained successful graft-take in all patients. Complete take was marred in 2 patients, over areas of BTM that had not integrated and graft application was performed too early. The BTM can be applied into wounds in humans and can integrate, persist in the presence of infection, and sustain split-skin overgrafting, despite the trial group presenting with significant comorbidities.

Introduction Traditional techniques for managing fingertip crush injuries with exposed deep structures often provide patients with suboptimal results. We present a method of fingertip amputation reconstruction using serial BTM application and full thickness skin grafting with good aesthetic and functional outcomes. Case Presentation We present a case of a 21-year-old female who sustained a severe crush injury from a fire door to her left ring fingertip. This resulted in total fingertip degloving distal to the distal interphalangeal joint with bone exposure. Following extensive deliberations with the patient, we decided to reconstruct the defect using layered Biodegradable Temporising Matrix (BTM) aiming to maintain the length and restore the glabrous pulp contour. The patient underwent two serial BTM applications to achieve the desired volume and length of the fingertip under local anaesthetic. Post BTM delamination and the fingertip underwent full thickness skin grafting. 1 month post-operatively the graft showed complete take and fingertip volume appeared restored. Overall, the fingertip has been reconstructed with no loss of length and with great aesthetic and functional outcome. Conclusions Severe fingertip amputations can traditionally be managed with flap reconstruction. However, this often does not have the desired aesthetic or functional outcome due to ill-restored fingertip volume and length. Dermal matrices, such as BTM, provide an operatively simple yet effective fingertip reconstructive technique with maintenance of length and restoration of finger volume when layered. Whilst multiple operations may not be acceptable for all patients, for those willing to comply we believe BTM provides a superior result.

Intrahepatic islet transplantation for type 1 diabetes is limited by the need for multiple infusions and poor islet viability posttransplantation. The development of alternative transplantation sites is necessary to improve islet survival and facilitate monitoring and retrieval. We tested a clinically proven biodegradable temporizing matrix (BTM), a polyurethane-based scaffold, to generate a well-vascularized intracutaneous “neodermis” within the skin for islet transplantation. In murine models, BTM did not impair syngeneic islet renal-subcapsular transplant viability or function, and it facilitated diabetes cure for over 150 days. Furthermore, BTM supported functional neonatal porcine islet transplants into RAG-1−/− mice for 400 days. Hence, BTM is nontoxic for islets. Two-photon intravital imaging used to map vessel growth through time identified dense vascular networks, with significant collagen deposition and increases in vessel mass up to 30 days after BTM implantation. In a preclinical porcine skin model, BTM implants created a highly vascularized intracutaneous site by day 7 postimplantation. When syngeneic neonatal porcine islets were transplanted intracutaneously, the islets remained differentiated as insulin-producing cells, maintained normal islet architecture, secreted c-peptide, and survived for over 100 days. Here, we show that BTM facilitates formation of an islet-supportive intracutaneous neodermis in a porcine preclinical model, as an alternative islet-transplant site.Article HighlightsHuman and porcine pancreatic islets were transplanted into a fully vascularized biodegradable temporizing matrix (Novosorb) that creates a unique intracutaneous site outside of the liver in a large-animal preclinical model.The intracutaneous prevascularized site supported pancreatic islet survival for 3 months in a syngeneic porcine-transplant model.Pancreatic (human and porcine) islet survival and function were demonstrated in an intracutaneous site outside of the liver for the first time in a large-animal preclinical model.

Skin and soft tissue reconstruction has long been based on the reconstructive ladder. However, a skin substitute has become popular due to its predictable outcomes, without donor-site morbidity. The biodegradable temporizing matrix (BTM; NovoSorb, PolyNovo Ltd., Port Melbourne, Australia) is a synthetic skin substitute that has recently gained its clinical application. Compared with those of other dermal templates, the clinical efficacy and performance of the BTM are not well established, especially among the Asian population. This study aims to share our experience and strategy of using BTM in various wound conditions. The data of patients who underwent skin and soft tissue reconstruction with BTM at a single institution between January 2022 and December 2023 were reviewed. The patient demographics, wound characteristics, surgical details, secondary procedures, and complications were recorded and analyzed. Postoperative 6-month photographs were collected and independently evaluated by two plastic surgeons and two wound care center nurses using the Manchester Scar Scale (MSS). This study included 37 patients, consisting of 22 males and 15 females with a mean age of 51.8 years (range, 18-86 years old). The wound etiologies included trauma (67.6%), necrotizing soft tissue infection (16.2%), burns (10.8%), toe gangrene (2.7%), and scar excision (2.7%). The average wound area covered by BTM was 50.6 ± 47.6 cm2. Among the patients, eight received concomitant flap surgery and BTM implantation, 20 (54.1%) underwent subsequent split-thickness skin grafts (STSG), and 17 had small wounds (mean: 21.6 cm2) healed by secondary intention. Infection was the most common complication, affecting six patients (n = 6 [16.2%]), five of whom were treated conservatively, and only one required debridement. Thirty-three patients (89.2%) had good BTM take, and only four had BTM failure, requiring further reconstruction. At the last follow-up, 35 out of the 37 patients (94.6%) achieved successful wound closure, and the total MSS score was 10.44 ± 2.94, indicating a satisfactory scar condition. The patients who underwent BTM grafting without STSG had better scar scores than those who received STSG (8.71 ± 2.60 vs. 11.18 ± 2.84, p = 0.039). In conclusion, the BTM is effective and feasible in treating various wounds, with relatively low complication rates, and it can thus be considered as an alternative for skin and soft tissue reconstruction. When combined with adipofasical flap reconstruction, it achieves a more comprehensive anatomical restoration.

Biodegradable temporizing matrix (BTM) is a synthetic biodegradable dermal matrix that helps develop a non-skin graft amenable wound bed (eg, over tendon or bone) into a graftable wound bed, by acting as an inert scaffold for angiogenesis and formation of granulation tissue. There is currently a paucity of evidence to encourage its use in scalp defects following skin malignancy excision. This retrospective analysis aimed to evaluate the utility of BTM in this patient subset. This is a case series of patients undergoing BTM reconstruction for scalp defects following skin malignancy excision between January 2022 and January 2024. Data collected included demographics, as well as oncological and reconstructive outcomes. Thirteen distinct BTM cases were identified in 12 patients. All patients were male with a median age of 85 years. Of 13 lesions, 10 were confirmed squamous cell carcinoma, with 3 confirmed as malignant melanoma. Of 13 cases, 12 required excision down to the calvaria, with 1 down to pericranium. Of 13 cases, 11 went on to receive a split-thickness skin graft (STSG) after BTM application, with a median interval of 46 days. All these patients had complete take of their subsequent STSG. Two cases did not receive STSG, 1 had satisfactorily healed upon delamination of the BTM, and 1 had failure of BTM due to bacterial colonization. This study demonstrates the utility of BTM as a successful, low morbidity reconstructive option in patients undergoing skin cancer excision on the scalp.

To assess the efficacy of biodegradable temporising matrix (BTM) in complex wound reconstruction. The authors conducted a systematic review and meta-analysis as per the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines following a literature search assessing BTM in complex wound reconstruction. The primary outcome measures included the proportion of BTM integration as well as integration time. Secondary outcomes included graft take over BTM, infection rate and other complications as well as scar outcome. Twenty six studies met the inclusion criteria with a total of 1153 complex wounds. The mean proportional integration was 92.7% at (95% confidence intervals [CI] 88.57, 96.87, p < 0.001) with a mean integration time of 34.05 days (95% CI 33.33, 34.79, p < 0.001). The infection rate was low at 12.6% with an untransformed proportion metric assessment (0.126, 0.08-0.168, p < 0.001) at the site of BTM application. Favourable scar outcomes were reported using the matching assessment using photographs with scars (MAPS) and patient and observer scar assessment scales (POSAS). BTM offers a robust dermal template in reconstruction of complex wounds. The authors recommend for randomised controlled trials to enhance the current evidence base.