Dr Justine O’Hara1, Professor Peter Maitz1, Dr Andrea Issler-Fisher1, Associate Professor Peter Haertsch1, Dr Kar-Soon Lim1, Mrs Oana Ditu1, Mrs Sue Taggart1
1Dr Justine O’Hara, Sydney, Australia
Biodegradable temporising matrix offers a valuable option in the reconstructive armamentarium, especially now for the large burn. We present the evolution of our units’ utilisation from initial coverage of small difficult wounds to a change in protocol for large burns.
We report the use of BTM in 37 patients in 54 episodes since November 2018. Twenty of these patients were significant TBSA burns. We report 9 patient failures with an education and evolution of practice in this time. This evolution in practice we wish to share to the benefit of other units.
BTM provides a dermal replacement which enables a fast burn excision with immediate placement to seal the wound bed. This reduces the challenges of immediate grafting, with bleeding and larger TBSA defect with concomitant inflammatory response. The other benefit recognised was reduced graft loss due to the patient being stabilised in ‘plastic’ during the early unstable phase requiring ionotropic support.
This change in protocol for larger burns enabled the intensive care to be managed with dressings to the BTM and the patient then be serially grafted once stable. The returns to theatre for elective grafting involved 1-3 sessions dependent on size of the burn with good graft take if BTM vascularised. This product was very stable with the timing range to delamination 15-78 days, with an average of 33 days.
The cost of BTM at approximately $1000/1%TBSA appears a significant cost if reviewed in isolation but if considered against the cost of a major burn is considered advantageous in our unit. This is an area of further study we look forward to providing in the future.
Dr Justine O’Hara is a Plastic and Reconstructive Surgeon working in Concord Burns Unit with and interest in biotechnologies and patient experience. She has a broad Plastic Surgical practice bringing innovation and new techniques to challenging cases.