Background
NovoSorb Biodegradable Temporising Matrix (BTM) is a two-stage dermal matrix recently approved by the TGA for treatment of full thickness defects of the skin. It is a completely synthetic material comprised of a biodegradable polyurethane foam bonded to a non-biodegradable fenestrated polyurethane sealing membrane. BTM offers potential advantages compared to traditional methods of reconstruction in terms of pliability and thickness of the reconstruction. We present our experience using BTM to reconstruct defects of the upper limb resulting from trauma and necrotizing soft tissue infection.
Methods
Patients with upper limb defects who were treated with BTM at Middlemore Hospital were identified. Patient demographics, indication for dermal matrix use, surgical details and complications were recorded using information gathered from the medical records.
Findings
This case series included seven patients with a median age of 58 years (range 28-76) and 71% were male. The defects resulted from traumatic loss (4 patients) and necrotizing soft tissue infection (3 patients). Six cases had complex defects with exposed bone or tendon that precluded immediate skin graft coverage. The mean time between the first and second stages was 5 weeks (range 4-8). One patient developed infection which was able to be successfully managed with topical wound care and antibiotics. The mean length of follow-up was 4.2 months (range 2–10).
Conclusions
BTM was found to be straightforward to use and produced excellent results in terms of contour and pliability of the reconstruction. It demonstrated several positive aspects compared to other dermal templates such as being able to test for capillary refill as a determinant of when it was ready for the second stage and being more tolerant to infection which could be managed with simple wound care without affecting neodermal formation or subsequent graft take.