Case 4 (2024): Wound healing and dermal regeneration in delayed presentation of a burn patient treated with NovoSorb® Biodegradable Temporising Matrix: A Case Study
K. Kaushal, D. Jordan, R. Majeed, L. Dingle . Dundee, Scotland
Abstract
The purpose of this case study is to describe the surgical treatment of a delayed presentation of a full thickness burn at an anatomically challenging area. We present a case an 81-year-old Scottish lady with a medical background of stroke, atrial fibrillation on Edoxaban who was not surgically fit. Patient was recovering from post COVID-vaccine-flu like symptoms at her residence when she sustaine
BeforeAfterThe purpose of this case study is to describe the surgical treatment of a delayed presentation of a full thickness burn at an anatomically challenging area. We present a case an 81-year-old Scottish lady with a medical background of stroke, atrial fibrillation on Edoxaban who was not surgically fit. Patient was recovering from post COVID-vaccine-flu like symptoms at her residence when she sustained 3% TBSA scald burn to her neck and anterior upper chest. She mentioned that she spilled milk tea onto herself, did not take off her clothing, and received no first aid of any kind. A week later she presented to our services when the pain got unbearable. She underwent surgical excision and Biodegradable Temporising Matrix (BTM) dressing with negative- pressure wound therapy then definitive split thickness skin graft after her infection settled down. She has healed well with a minimal- no neck contracture.
Tangential excision using Watson knife on anterior chest and versajet on neck
2
Negative Pressure Wound Therapy (NPWT) is used to help the drainage of excess fluid and increase localised blood flow. It has been suggested that the action of NPWT may result in the burn being supplied with increased oxygen and nutrition which could promote healing.
3
A promising option for achieving satisfactory aesthetic outcomes is reconstruction using synthetic matrices. Biodegradable Temporising Matrix (BTM) has shown promise as a novel dermal substitute used in complex burns healing, deep infected wounds, reconstruction of subfascial defects and necrotising fasciitis. It is a 2-mm thick synthetic dermal template, with a biodegradable polyurethane open-cell foam bonded via a polyurethane adhesive layer to a superficial transparent nonbiodegradable polyurethane sealing membrane requiring a two stage wound reconstruction in the mainstay. In the first stage, BTM provides physiological wound cover, with fenestration to avoid accumulation of underlying materials, into which cells and blood vessels migrate to form a neodermis. As granulation tissue grows into the foam matrix, the foam itself biodegrades, ultimately leaving a graftable surface. A split thickness skin graft was considered for the second stage. BTM has antibacterial properties and does not supply nutrients from animal tissue in comparison to other dermal substitutes and been demonstrated to be cost effective with greater vascularisation and inflammatory response when compared with other dermal substitutes.
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BTM in 4 weeks time, before delaminating BTM for 2nd stage reconstruction.
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2nd stage reconstruction using a sheet split thickness skin graft was used and supported by NPWT dressing.
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1st graft check, post operative day 5.
7Graft check in 3 weeks time, healing with no issue. Patient was given appointments with the physiotherapy after this appointment.
- Burn wound was successfully closed with difficult anatomical region for grafting and delayed presentation of infected burn were considered, then this two-stage strategy of BTM implantation followed by later SSG was carried out.
How to cite this article
K. Kaushal, D. Jordan, R. Majeed, L. Dingle . Dundee, Scotland. Case 4 (2024): Wound healing and dermal regeneration in delayed presentation of a burn patient treated with NovoSorb® Biodegradable Temporising Matrix: A Case Study. Journal of Plastic, Breast & Reconstructive Surgery. 2024.
Open access. © 2024 The Author(s). Published by the Journal of Plastic, Breast & Reconstructive Surgery. Copyright to this case is shared between the author(s) and the journal; authors may reuse their own case for education, presentations and social media.
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