Dr Samuel Chu1, Dr Jeremy Rawlins1
1Fiona Stanley Hospital – State Burns Service of Western Australia, Perth, Australia
This case report describes a novel use of lower leg fasciotomies and NovoSorbⓇ Biodegradable Temporising Matrix (“BTM”) in the elective setting of treating a patient with rapidly advancing systemic sclerosis.
We present a 51-year-old male with rapidly progressive diffuse systemic sclerosis which was refractory to medical treatment of prednisolone, upadacitinib, mycophenolate and methotrexate. Within six months of diagnosis, the systemic sclerosis had progressed up to his knees rendering it difficult to walk due to tight compartments affecting motion. He was referred to our service for management with regards to mobility.
We performed elective bilateral lower leg fasciotomies, releasing his lower leg compartments to good effect. BTM was applied with a silver interface together with foam negative pressure wound therapy. The patient was discharged once he was comfortable and managing analgesia.
The remaining operative plan is to eventually delaminate the BTM and reconstruct the remaining defects with the use of split thickness skin grafts.
BTM is well described in the literature and is widely used in the setting of reconstruction of major burns, necrotising fasciitis and traumatic tissue loss (Wagstaff et al., 2019; Solanki et al., 2020). Its use in the elective setting is however not well described. Its use in this case is complementary to the novel approach of using fasciotomies to help a patient regain mobility when suffering from tight compartments due to rapidly advancing systemic sclerosis.
Solanki, N. S. et al. (2020) ‘A consecutive case series of defects reconstructed using NovoSorbⓇ Biodegradable Temporising Matrix: Initial experience and early results’, Journal of Plastic, Reconstructive and Aesthetic Surgery, pp. 1845–1853.
Wagstaff, M. J. D. et al. (2019) ‘Biodegradable Temporising Matrix (BTM) for the reconstruction of defects following serial debridement for necrotising fasciitis: A case series’, Burns Open, pp. 12–30.
Dr Samuel Chu is a surgical service registrar working in Western Australia with a keen interest in plastic & reconstructive surgery