Chen Angela Chien-Yu, Lin Tsuo-Wu, Chang Ke-Chung, Chang Dun-Hao
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan.
Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan.
J Funct Biomater. 2024 May 18;15(5):136. doi: 10.3390/jfb15050136.
Skin and soft tissue reconstruction has long been based on the reconstructive ladder. However, a skin substitute has become popular due to its predictable outcomes, without donor-site morbidity. The biodegradable temporizing matrix (BTM; NovoSorb, PolyNovo Ltd., Port Melbourne, Australia) is a synthetic skin substitute that has recently gained its clinical application. Compared with those of other dermal templates, the clinical efficacy and performance of the BTM are not well established, especially among the Asian population. This study aims to share our experience and strategy of using BTM in various wound conditions. The data of patients who underwent skin and soft tissue reconstruction with BTM at a single institution between January 2022 and December 2023 were reviewed. The patient demographics, wound characteristics, surgical details, secondary procedures, and complications were recorded and analyzed. Postoperative 6-month photographs were collected and independently evaluated by two plastic surgeons and two wound care center nurses using the Manchester Scar Scale (MSS). This study included 37 patients, consisting of 22 males and 15 females with a mean age of 51.8 years (range, 18-86 years old). The wound etiologies included trauma (67.6%), necrotizing soft tissue infection (16.2%), burns (10.8%), toe gangrene (2.7%), and scar excision (2.7%). The average wound area covered by BTM was 50.6 ± 47.6 cm. Among the patients, eight received concomitant flap surgery and BTM implantation, 20 (54.1%) underwent subsequent split-thickness skin grafts (STSG), and 17 had small wounds (mean: 21.6 cm) healed by secondary intention. Infection was the most common complication, affecting six patients ( = 6 [16.2%]), five of whom were treated conservatively, and only one required debridement. Thirty-three patients (89.2%) had good BTM take, and only four had BTM failure, requiring further reconstruction. At the last follow-up, 35 out of the 37 patients (94.6%) achieved successful wound closure, and the total MSS score was 10.44 ± 2.94, indicating a satisfactory scar condition. The patients who underwent BTM grafting without STSG had better scar scores than those who received STSG (8.71 ± 2.60 vs. 11.18 ± 2.84, = 0.039). In conclusion, the BTM is effective and feasible in treating various wounds, with relatively low complication rates, and it can thus be considered as an alternative for skin and soft tissue reconstruction. When combined with adipofasical flap reconstruction, it achieves a more comprehensive anatomical restoration.
皮肤和软组织重建长期以来一直基于重建阶梯。然而，一种皮肤替代物因其可预测的结果且无供区并发症而受到欢迎。可生物降解的临时基质（BTM；NovoSorb，PolyNovo有限公司，澳大利亚墨尔本港）是一种合成皮肤替代物，最近已获得临床应用。与其他真皮模板相比，BTM的临床疗效和性能尚未得到充分证实，尤其是在亚洲人群中。本研究旨在分享我们在各种伤口情况下使用BTM的经验和策略。回顾了2022年1月至2023年12月在单一机构接受BTM进行皮肤和软组织重建的患者数据。记录并分析了患者的人口统计学、伤口特征、手术细节、二次手术和并发症情况。收集术后6个月的照片，并由两名整形外科医生和两名伤口护理中心护士使用曼彻斯特瘢痕量表（MSS）进行独立评估。本研究包括37例患者，其中男性22例，女性15例，平均年龄51.8岁（范围18 - 86岁）。伤口病因包括创伤（67.6%）、坏死性软组织感染（16.2%）、烧伤（10.8%）、趾坏疽（2.7%）和瘢痕切除（2.7%）。BTM覆盖的平均伤口面积为50.6±47.6平方厘米。在这些患者中，8例接受了同期皮瓣手术和BTM植入，20例（54.1%）随后接受了断层皮片移植（STSG），17例小伤口（平均：21.6平方厘米）通过二期愈合。感染是最常见的并发症，影响6例患者（n = 6 [16.2%]），其中5例接受保守治疗，仅1例需要清创。33例患者（89.2%）BTM植入成功，仅4例BTM失败，需要进一步重建。在最后一次随访时，37例患者中有35例（94.6%）伤口成功闭合，MSS总分10.44±2.94，表明瘢痕状况良好。未接受STSG而接受BTM移植的患者瘢痕评分优于接受STSG的患者（8.71±2.60 vs. 11.18±2.84，P = 0.039）。总之，BTM在治疗各种伤口方面有效且可行，并发症发生率相对较低，因此可被视为皮肤和软组织重建的一种替代方法。当与脂肪筋膜皮瓣重建相结合时，可实现更全面的解剖修复。
