Dr Elizabeth Concannon1, Dr Robert Marriott1, Dr Nicholas Solanki1
1Royal Adelaide Hospital, , Australia
Objectives: A 70-year-old male presented with 20% total body surface area flame burns,involving his anterior chest wall. His burn wounds were debrided and temporised with a dermal substitute[NovoSorb® Biodegradable Temporising Matrix (BTM)]. His post-operative course was complicated by acute coronary syndrome requiring coronary artery bypass grafting via sternotomy through BTM integrating into the chest wall wounds. Subsequent operative management presented a unique challenge for the treating burns and cardiothoracic surgeons involved in his care. Methods: We describe a previously unreported application of BTM for burn wound reconstruction using a technique that facilitated a surgical incision to carry out open cardiac surgery without compromising wound healing. Results: The patient proceeded to complete BTM integration despite its division for sternotomy incision with excellent graft take and uncomplicated healing. Discussion: Clinical studies suggest that patients with burn injuries may have a long-term increased risk of cardiac complications with increased hospital admissions and length of stay for cardiovascular disease compared to a matched non-burn cohort. Burn wound reconstruction using two-staged BTM application followed by split thickness skin grafting was the optimal management plan for the medically co-morbid elderly patient described. BTM offered the following advantages in this patients treatment: (a) Minimising the acute physiological insult and fluid shift by avoiding the creation of donor site wounds during the initial debridement procedure (b) Optimising scar cosmesis and reducing burn contracture formation by the formation of a neodermis prior to skin graft application; and (c) Allowing for staged reconstruction using split thickness skin grafts within the limits of anaesthetic stability. Conclusion: Satisfactory sternotomy wound healing following incision through BTM demonstrates the versatility and reliability of this staged burn wound reconstruction protocol.
Elizabeth Concannon, MB BAO BCh MCh FRCS(Plast), is a Plastic Surgery Fellow from Galway, Ireland who has completed burns fellowship training at the ABA Verified Royal Adelaide Hospital burns unit in 2021.