Dr. Michael A. J. Rooke1, A/Prof. John E. Greenwood2, Mr. Marcus J. D. Wagstaff3
1 Adult Burns Service, Royal Adelaide Hospital, North Tce. Adelaide SA 5000, email@example.com
2 Adult Burns Service, Royal Adelaide Hospital, North Tce. Adelaide SA 5000, firstname.lastname@example.org
3 Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, North Tce. Adelaide SA 5000, email@example.com
Joint contractures are a major source of morbidity in patients with severe burns, significantly limiting their recovery and independence. Traditional approaches in managing these injuries have relied on early excision, grafting and secondary revision of the contracted graft when joint restriction or tendon tethering develops. At our institution, we have begun to use Biodegradable Temporising Matrix (BTM) as an intermediate step in managing joint burns. BTM offers multiple advantages over traditional approaches to reconstructing burn-related joint pathology. Firstly, two stage reconstruction using a neo-dermis such as that produced by BTM creates an intermediate layer over the joint; this minimises tethering related to grafting. BTM can also be used to temporarily cover the joint while waiting for donor sites to regenerate and does so without impeding regular physiotherapy.
In a series of three patients (2 males, 1 female, all >35% TBSA) we review our experience and results using BTM. BTM was used to manage acute joint pathology across six limbs (four legs, four arms in total). Additionally, subacute joint releases (neck, axilla) were performed at three months in one of these patients. All three patients suffered no significant complications related to the implant. At the time of submission two patients were still awaiting definitive grafting of their BTM but were demonstrating good active and passive range of motion while covered solely with polymer. Our results demonstrate that using BTM is a novel, viable approach to the management of acute burn injuries involving major joints as well as reconstructing burn-related joint contractures.
Surgery, Reconstruction, Joint Release
Dr. Rooke is the current Burns Registrar for the Adult Burns Service at the Royal Adelaide Hospital.