Case 4 (2024): Wound healing and dermal regeneration in delayed presentation of a burn patient treated with NovoSorb® Biodegradable Temporising Matrix: A Case Study

K. Kaushal; D. Jordan; R. Majeed; L. Dingle . Dundee

Journal of Plastic, Breast & Reconstructive Surgery·Peer-reviewed, open-access surgical case reportsPeer-reviewed · Open access

Case 4 (2024): Wound healing and dermal regeneration in delayed presentation of a burn patient treated with NovoSorb® Biodegradable Temporising Matrix: A Case Study · JPBRS

Case report

Case 4 (2024): Wound healing and dermal regeneration in delayed presentation of a burn patient treated with NovoSorb® Biodegradable Temporising Matrix: A Case Study

K. Kaushal, D. Jordan, R. Majeed, L. Dingle . Dundee

Published March 31, 2024534 views4 min read

Biodegradable Temporising MatrixNovoSorb®Biodegradable polyurethaneDermal matrixBurnFull-thickness burnsSkin graft

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Abstract

Key learning points

Pearls

Burn wound was successfully closed with difficult anatomical region for grafting and delayed presentation of infected burn were considered, then this two-stage strategy of BTM implantation followed by later SSG was carried out.

Pitfalls

Longer duration of stay in the hospital.

Patient history

The purpose of this case study is to describe the surgical treatment of a delayed presentation of a full thickness burn at an anatomically challenging area. We present a case an 81-year-old Scottish lady with a medical background of stroke, atrial fibrillation on Edoxaban who was not surgically fit. Patient was recovering from post COVID-vaccine-flu like symptoms at her residence when she sustained 3% TBSA scald burn to her neck and anterior upper chest. She mentioned that she spilled milk tea onto herself, did not take off her clothing, and received no first aid of any kind. A week later she presented to our services when the pain got unbearable. She underwent surgical excision and Biodegradable Temporising Matrix (BTM) dressing with negative- pressure wound therapy then definitive split thickness skin graft after her infection settled down. She has healed well with a minimal- no neck contracture.

Examination

Patient presented with fever, a Tmax of 39 degrees centigrade and tachycardia of 100bpm. The burn was of full thickness in nature over her anterior upper chest and neck sparing the back and nape of neck, 3% TBSA, measured using patient’s palmer surface. The burns were non blanching and non-tender in the centre however slightly tender around the zone of hyperaemia. The microbiology wound swab taken on day of admission grew Staphylococcus aureus, Group B Streptococci and Streptococcus dysgalactie. Patient was put on empirical antibiotics which was later changed to co-trimoxazole. Patient was a non-smoker, independent person and on blood thinner. Other than the areas mentioned, there was no injury sustained elsewhere.

Pre-operative considerations

The Infected burn was taken to theatre for excision and negative pressure wound therapy until the microbiology team cleared off the pathogens for definitive treatment. The patient was given empirical antibiotics according to hospital protocol. Bloods : Complete blood count, Urea and creatinine, coagulation profile, ECG, Cross match, group and save. Patient was referred to cardiology team as the patient developed atrial fibrillations in the ward.

Step 1 — Excision of burn

References

Lo CH, Brown JN, Dantzer EJG, et al. Wound healing and dermal regeneration in severe burn patients treated with NovoSorb® Biodegradable Temporising Matrix: A prospective clinical study. Burns. 2022;48(3):529-538. doi:10.1016/J.BURNS.2021.07.014
Wagstaff MJ, Caplash Y, Greenwood JE. Reconstruction of an Anterior Cervical Necrotizing Fasciitis Defect Using a Biodegradable Polyurethane Dermal Substitute. Eplasty. 2017;17:e3. Accessed May 2, 2023. https://pubmed.ncbi.nlm.nih.gov/28197297/
Solanki NS, York B, Gao Y, Baker P, Wong She RB. A consecutive case series of defects reconstructed using NovoSorbⓇ Biodegradable Temporising Matrix: Initial experience and early results. J Plast Reconstr Aesthet Surg. 2020;73(10):1845-1853. doi:10.1016/J.BJPS.2020.05.067
PolyNovo UK Ltd. UK Healthcare Pavilion. https://ukhealthcarepavilion.com/articles/polynovo-launches-pioneering-novosorb-btm-synthetic-wound-matrix-technology-at-medica-2021/.
Cheshire PA, Herson MR, Cleland H, Akbarzadeh S. Artificial dermal templates: A comparative study of NovoSorbTM Biodegradable Temporising Matrix (BTM) and Integra® Dermal Regeneration Template (DRT). Burns. 2016;42(5). doi:10.1016/j.burns.2016.01.028