Plastic Surgery Department, University Hospital Coventry and Warwickshire, Coventry, UK.
J Wound Care. 2023 Aug 2;32(8):470-478. doi: 10.12968/jowc.2023.32.8.470.
NovoSorb (Poly-Novo Ltd, Australia) biodegradable temporising matrix (BTM) is a novel artificial dermal matrix. Previous literature is weighted towards its use in burns reconstruction; however, this paper describes its use within a range of wound aetiologies. The authors present one of the largest and most diverse case series to date, and aim to provide an independent benchmark of clinical practice.
A retrospective observational study was performed. Patient demographics and clinical data (wound aetiology, site, total body surface area (TBSA), wound bed, number of debridements, time to BTM integration, time to skin grafting) were collected and subgroup analysis preformed.
The cohort consisted of 37 patients (acute trauma wounds, n=19; hard-to-heal wounds, n=9; acute infections, n=6; cancer, n=3). Successful BTM integration, allowing subsequent split-thickness skin grafting (STSG), occurred in 70% of cases, despite an overall complication rate of 51%. Mean time from BTM application to STSG was 53 days. There was no difference in STSG outcomes when grafting was performed either before or after the six-week BTM application period. There was no difference when various wound beds (fascia, tendon, periosteum) were compared. Patients >65 years of age were more likely to experience complications; however, this did not affect the speed of integration. The relation of diabetes and smoking to overall integration had no statistical significance.
In comorbid patients in particular, the time between BTM application and STSG may be longer than the manufacturer's recommendation. Furthermore, data suggest greater wound bed optimisation and closer interval monitoring in hard-to-heal/malignant wounds, and in older patients and patients with comorbidities. However, BTM appears robust (even in infection) and is showing promise as a useful reconstructive tool.
NovoSorb（澳大利亚 Poly-Novo 有限公司）可生物降解临时基质（BTM）是一种新型的人工真皮基质。之前的文献主要集中在其在烧伤重建中的应用；然而，本文描述了其在多种创伤病因中的应用。作者展示了迄今为止最大和最多样化的病例系列之一，并旨在提供临床实践的独立基准。
进行了一项回顾性观察性研究。收集了患者的人口统计学和临床数据（创伤病因、部位、体表面积（TBSA）、创面床、清创次数、BTM 融合时间、皮肤移植时间），并进行了亚组分析。
该队列包括 37 名患者（急性创伤性伤口，n=19；难愈性伤口，n=9；急性感染，n=6；癌症，n=3）。尽管总体并发症发生率为 51%，但 70%的病例成功融合 BTM，允许随后进行刃厚皮片移植（STSG）。从 BTM 应用到 STSG 的平均时间为 53 天。在 BTM 应用六周后进行或之前进行 STSG 时，其结果没有差异。比较不同的创面床（筋膜、肌腱、骨膜）时，结果也没有差异。年龄大于 65 岁的患者更有可能出现并发症；然而，这并不影响融合速度。糖尿病和吸烟与整体融合的关系没有统计学意义。
特别是在合并症患者中，从 BTM 应用到 STSG 的时间可能比制造商的建议长。此外，数据表明，在难愈性/恶性伤口以及老年患者和合并症患者中，需要更好地优化创面床，并更密切地监测间隔时间。然而，BTM 似乎很稳健（即使在感染中也是如此），并有望成为一种有用的重建工具。
