Dr Elizabeth Concannon1, Dr Emma Rose1, Dr Lindsay Damkat Thomas1, Mr Nicholas Solanki1, Mr Marcus Wagstaff1, Professor John Greenwood1
1Royal Adelaide Hospital, , Australia
Objectives: The aim of this study was to investigate the role of a synthetic dermal matrix, Biodegradable Temporising Matrix (BTM), for coverage of complex wounds. The authors defined complex wounds as wounds not amenable to reconstruction with skin grafting alone due to an inherent avascularity such as the presence of denuded bone, tendinous or neural structures. Methods: A retrospective review of a prospectively maintained database of complex wounds, as defined, was carried out. Clinical and operative notes were reviewed along with a review of an extensive photographic database demonstrating wound healing progress using staged BTM and autologous skin graft reconstruction. Results: 56 patients were identified who underwent staged BTM and autologous skin graft reconstruction for complex wounds affecting a wide variety of patient demographics, treatment indications and body sites. Wound aetiology varied between burn injury, non-burn related trauma including degloving injury and infective complications. We discuss caveats relating to successful application of staged BTM reconstruction, technique tips,prevention and management of complications. Discussion: Dermal substitutes play an integral role in providing biological wound cover for avascular wound beds which may otherwise require complex distant flap or microsurgical free flap reconstruction. Our department has developed significant expertise in the use of BTM throughout its development from initial animal studies through to human clinical trials. BTM has proven robustness in the face of unfavourable wounds compared with other popular dermal matrices, physiologically covering avascular structures, allowing for early graft take, expediting rehabilitation and mobilisation with excellent scar cosmesis. Conclusion: Dermal matrices play an important role in complex wound healing, achieving excellent results with a low complication profile. BTM has provided a valuable alternative to free-tissue transfer in patients with significant co-morbidities, vascular insufficiency and/or those for whom long operations/anaesthetics are undesirable.
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.