Minimalistic reconstruction of exposed skull in a complex craniovertebral polytrauma

A review of NovoSorb Biodegradable Temporising Matrix use over a 12-month period, with a focus on reconstructive salvage after free flap failure illustrated by a short case series

We present a retrospective, cross-sectional review of 12 patients who underwent surgical reconstruction with NovoSorb® Biodegradable Temporising Matrix (BTM) over 1 year for trauma, cancer resection, necrotising fasciitis and chronic wounds. We report an overall success rate of BTM in 83% of cases. Three key cases are described in detail to show how BTM was successfully used as a means of reconstructive salvage after total or partial free flap failures for circumferential soft tissue defects that might otherwise have required a second free flap or limb amputation. The indications for BTM in non-burns wound closure are growing and our experience demonstrates it can provide a reliable 'salvage' reconstruction where traditional free flaps have failed and further tissue transfer is judged to have a poor risk-benefit ratio. We highlight BTM as an increasingly versatile tool in the armamentarium of reconstructive surgeons faced with challenging wounds including in the failed free flap setting and encourage further research on these advanced applications.

Blood Plasma, Fibrinogen or Fibrin Biomaterial for the Manufacturing of Skin Tissue-Engineered Products and Other Dermatological Treatments: A Systematic Review

The use of blood plasma, fibrinogen or fibrin, a natural biomaterial, has been widely studied for the development of different skin tissue-engineered products and other dermatological treatments. This systematic review reports the preclinical and clinical studies which use it alone or combined with other biomaterials and/or cells for the treatment of several dermatological conditions. Following the PRISMA 2020 Guidelines, 147 preclinical studies have revealed that the use of this biomaterial as a wound dressing or as a monolayer (one cell type) skin substitute are the preferred strategies, mainly for the treatment of excisional or surgical wounds. Moreover, blood plasma is mainly used alone although its combination with other biomaterials such as agarose, polyethylene glycol or collagen has also been reported to increase its wound healing potential. However, most of the 17 clinical reviewed evaluated its use for the treatment of severely burned patients as a wound dressing or bilayer (two cell types) skin substitute. Although the number of preclinical studies evaluating the use of blood plasma as a dermatological treatment has increased during the last fifteen years, this has not been correlated with a wide variety of clinical studies. Its safety and wound healing potential have been proved; however, the lack of a standard model and the presence of several approaches have meant that its translation to a clinical environment is still limited. A higher number of clinical studies should be carried out in the coming years to set a standard wound healing strategy for each dermatological disease.

Long-Term Histological Evaluation of a Novel Dermal Template in the Treatment of Pediatric Burns

For pediatric patients with full-thickness burns, achieving adequate dermal regeneration is essential to prevent inelastic scars that may hinder growth. Traditional autologous split-thickness skin grafts alone often fail to restore the dermal layer adequately. This study evaluates the long-term effect of using a NovoSorb® Biodegradable Temporizing Matrix (BTM) as a dermal scaffold in four pediatric patients, promoting dermal formation before autografting. Pediatric burn patients treated at the University Children's Hospital Zurich between 2020 and 2022 underwent a two-step treatment involving NovoSorb® BTM application, followed by autografting. Histological analysis, conducted through 22 punch biopsies taken up to 2.6 years post-application, demonstrated robust dermal reorganization, with mature epidermal regeneration and stable dermo-epidermal connections. Immunofluorescence staining showed rapid capillary ingrowth, while extracellular matrix components, including collagen and elastic fibers, gradually aligned over time, mimicking normal skin structure. By 2.6 years, the dermal layer displayed characteristics close to uninjured skin, with remnants of NovoSorb® BTM degrading within five months post-application. This study suggests that NovoSorb® BTM facilitates elastic scar formation, offering significant benefits for pediatric patients by reducing functional limitations associated with inelastic scarring.

Novosorb® BTM- history, production and application in challenging wounds

Novosorb® Biodegradable Temporising Matrix (BTM) is an entirely synthetic dermal matrix that is gaining popularity in the management of challenging wounds. Not only does it provide a framework in which to grow an organised neodermis, it is also especially resistant to infection. Today, the matrix is available as a 2 mm thick open cell polyurethane foam with a non-degrading sealing membrane. Its current form is the result of numerous in vitro and in vivo experiments that examined its shape, biodegradation, inflammatory response, and cytotoxicity. Clinical data on the use of BTM in a variety of cases is novel and presents early insights into its ability to foster wound healing where otherwise improbable. This review presents the history and development of Novosorb® BTM as well as all the currently available clinical data on its efficacy in difficult wounds such as: major burns, necrotising soft tissue infection, chronic wounds and in non graftable wound beds.

Outcomes of Biodegradable Temporizing Matrix for Soft Tissue Reconstruction of the Hand and Extremities

Background

NovoSorb biodegradable temporizing matrix (BTM) is a novel, bilayer, synthetic skin substitute made of biodegradable polyurethane foam covered with a sealing membrane. BTM has demonstrated excellent outcomes in burn literature; however, few studies have been published for hand and extremity soft tissue reconstruction.

Methods

All patients who underwent extremity reconstruction with BTM from 2018 to 2023 were reviewed. Demographics, presentations, and clinical outcomes were recorded.

Results

A total of 86 cases from 54 patients (53.7% pediatric; age range: 0-81 years) were included. Common indications included trauma (36%), infection (18.6%), and malignancy (11.6%). BTM was placed over exposed tendon (38.4%), bone (19%), joints (12.8%), nerves (8.1%), and/or blood vessels (7%). BTM served as temporary wound coverage in 26 cases. Complications included hematoma (8.1%), infection (4.7%), and spontaneous delamination (4.7%). Wound closure was successfully obtained without flap use in 93.3%. Poor BTM take was associated with peripheral vascular disease, hypertension, immunosuppression, and BTM hematoma and infection (<0.05).

Conclusion

This study contributes to the growing body of evidence favoring BTM use in challenging reconstructive cases. Although prospective comparative studies are forthcoming, BTM likely has broad applications in reconstructive surgery.

Reconstruction of a Near-total Scalp Avulsion with NovoSorb Biodegradable Temporizing Matrix: Pediatric Case Report

Traumatic dog bites of the face and head are common among the pediatric population, although injuries resulting in total or subtotal scalp avulsions are rare and life-threatening. Standard treatment in these cases includes attempts at replantation or free tissue transfer; however, these procedures may not always be possible. An alternative treatment option involves the use of dermal substitutes, such as Integra (Integra LifeScience Corporation), with subsequent skin grafting. More recently, an alternative skin substitute called NovoSorb Biodegradable Temporizing Matrix (BTM) (PolyNovo North America LLC) has displayed favorable reconstructive outcomes in recent burn literature. NovoSorb BTM is a novel, fully synthetic bilayer scaffold made of biodegradable polyurethane matrix covered with a sealing membrane. In this report, the authors describe a 3-year-old boy who presented emergently with a severe dog bite avulsion to the subpericranial level of approximately 80% of his scalp, which was not replantable. The surgical plan involved a staged reconstruction using Integra and later skin grafting. Purulent infection ensued and required removal of Integra less than 2 weeks from application. Upon clearing of the infection, the wound was successfully closed with BTM and subsequent skin grafting. With proper wound management and over 6 months of follow-up, the patient experienced excellent healing of the graft with stable calvarial coverage and an acceptable aesthetic outcome. He will undergo tissue expansion of the remaining hair-bearing scalp in the future.

A novel use for the biodegradable temporizing matrix

Biodegradable Temporising Matrix (BTM), a skin substitute, has been recently developed as a novel adjunct to the plastic surgeon’s reconstructive repertoire. Its use has been described in literature in a variety of settings and complex wounds, including those that previously would have been described as “non-graftable”, with favourable outcomes. We present the case of a patient with a wound to the right foot and ankle following extravasation injury. Following surgical debridement, this injury was managed with BTM, which allowed granulation and production of a “neo-dermis”. A split-thickness skin graft was subsequently applied. The characteristics of the BTM allowed the resulting skin graft and scar to be pliable, avoiding tendon tethering and joint contracture. To the authors’ knowledge, this skin substitute has not been reported in a wound of this aetiology before. It is our hope that this report will provide evidence to colleagues that this is a valuable adjunct that may be used in complex wounds.

Level of evidence: Level V, therapeutic study.

Minimally Invasive Successful Reconstruction of a Severely Traumatized Upper Extremity Using Platelet-Rich Plasma and Tissue Scaffold: A Case Report

Minimally invasive reconstruction combines principles of tissue engineering and regenerative medicine for healing complex wounds. This approach was successfully demonstrated on a 64-year-old diabetic and hypertensive male patient, who was brought unconscious to our emergency after surviving an automobile collision with severe brain and right-dominant upper extremity injuries. Uncontrolled hyperglycemia, severe anemia, diffuse axonal brain injury, wrist drop, and loss of thumb extension and abduction were noted. Extensive degloving, skin necrosis, extensor and flexor forearm muscle crush injuries, and ruptured extensor tendons were observed. Serial wound debridement combined with platelet-poor plasma injection into the muscles, platelet-rich plasma injections into the tendons and subcutis, and low-negative pressure wound therapy were performed sequentially to salvage the injured soft-tissues. Improvements were noticed during the second exploration after 5 days. Surviving muscles showed adequate vascularization and revival of innervation during the third exploration after another 5 days. Thereafter, absorbable synthetic tissue scaffold was applied over a sizeable 270 cm ² wound as a flap-alternative. Tissues regenerated well within the scaffold during the next 2 months, halving the wound area to 132 cm ² . A thick split-skin graft was applied over the remaining granulating neodermis, which “took” completely. Six months postoperatively, the patient regained most hand functions and performed all activities satisfactorily, while the grafted area appeared almost identical to surroundings. Minimally invasive reconstruction thus produced satisfying results with fewer shorter simpler surgeries, minimal anesthesia, short-duration hospitalization, lower health care costs, lesser risks, and excellent patient-reported outcomes.