With developments in new medical technologies and devices, we are seeing a paradigm shift into the management of patients needing complex reconstruction. These developments are being driven by the need for a more elegant reconstruction in patients with wounds that do not simply conform to the reconstructive ladder. These patients may have wounds which do not support a skin graft and may not be an appropriate candidate for flap reconstruction. This may be due to the nature or location of the wound or patient factors. Dermal substitutes have been developed with varying degrees of success in an attempt to address these issues. Potential risks associated with these products include immunogenic rejection and potential disease transmission. A biodegradable temporising matrix (BTM) has been developed as an entirely synthetic product used as an implantable dressing to promote a wound bed which is amenable to support a delayed skin graft.
Although the development of BTM is new, its clinical applications are diversifying. Traditionally used in the management of pressure ulcers and immediate free-flap donor site wounds, we are now seeing its use in burns and necrotising soft tissue infections.
We present a case series of three patients demonstrating the diversity in application of BTM and successful delayed skin grafting. These cases are unique and to our knowledge, have not been previously described in the literature.
Case 1
A 47-year-old female with delayed abdominal donor wound dehiscence and necrosis following deep inferior epigastric artery perforator (DIEP) flap reconstruction for breast cancer.
Case 2
A 61-year-old female with necrotising fasciitis with previously failed delayed split thickness skin grafts.
Case 3
A 72-year old diabetic with significant peripheral vascular disease, with a heel defect involving exposed calcaneum following partial calcanectomy for osteomyelitis.