The Role of Biodegradable Temporizing Matrix in Paediatric Reconstructive Surgery
Abstract
1. Introduction
2. Patients and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Struble, S.L.; Patel, N.K.; Graham, E.M.; Tipps, J.A.B.; Vaile, J.R.B.; Leeflang, E.J.; Goodwin, I.; Mendenhall, S.D. Outcomes of Biodegradable Temporizing Matrix for Soft Tissue Reconstruction of the Hand and Extremities. Plast. Reconstr. Surg.-Glob. Open 2024, 12, e5956. [Google Scholar] [CrossRef]
- Najem, S.; Fattouh, M.; Wintges, K.; Schoof, B.; Koerner, M.; Reinshagen, K.; Koenigs, I. NovoSorb® Biodegradable Temporizing Matrix: A novel approach for treatment of extremity avulsion injuries in children. Eur. J. Trauma Emerg. Surg. 2024, 50, 1807–1815. [Google Scholar] [CrossRef] [PubMed]
- Schlottmann, F.; Obed, D.; Bingöl, A.S.; März, V.; Vogt, P.M.; Krezdorn, N. Treatment of Complex Wounds with NovoSorb® Biodegradable Temporising Matrix (BTM)—A Retrospective Analysis of Clinical Outcomes. J. Pers. Med. 2022, 12, 2002. [Google Scholar] [CrossRef] [PubMed]
- Solanki, N.S.; York, B.; Gao, Y.; Baker, P.; She, R.B.W. A consecutive case series of defects reconstructed using NovoSorb® Biodegradable Temporising Matrix: Initial experience and early results. J. Plast. Reconstr. Aesthetic Surg. 2020, 73, 1845–1853. [Google Scholar] [CrossRef] [PubMed]
- Tapking, C.; Thomas, B.F.; Hundeshagen, G.; Haug, V.F.M.; Gazyakan, E.; Bliesener, B.; Bigdeli, A.K.; Kneser, U.; Vollbach, F.H. NovoSorb® Biodegradable Temporising Matrix (BTM): What we learned from the first 300 consecutive cases. J. Plast. Reconstr. Aesthetic Surg. 2024, 92, 190–197. [Google Scholar] [CrossRef] [PubMed]
- Grande, P.K.; Hill, D.; McElfresh, J.; Velamuri, R.; Liu, X. Systematic Review and Meta-analysis of Biodegradable Temporizing Matrix Application for Complex Wound Reconstruction. J. Burn. Care Res. 2024, 46, 82–89. [Google Scholar] [CrossRef] [PubMed]
- Storey, K.; Lalloz, M.; Choy, K.-T.; McBride, C.A.; McMillan, C.; Das Gupta, R.; Patel, B.; Choo, K.; Stefanutti, G.; Borzi, P.; et al. The versatility of biodegradable temporising matrix—A 63 paediatric case series with complex wounds. Burn. Open 2023, 7, 44–50. [Google Scholar] [CrossRef]
- Lo, C.H.; Brown, J.N.; Dantzer, E.J.G.; Maitz, P.K.; Vandervord, J.G.; Wagstaff, M.J.; Barker, T.M.; Cleland, H. Wound healing and dermal regeneration in severe burn patients treated with NovoSorb® Biodegradable Temporising Matrix: A prospective clinical study. Burns 2022, 48, 529–538. [Google Scholar] [CrossRef] [PubMed]
- Cereceda-Monteoliva, N.; Rela, M.; Borges, A.; Dheansa, B. Early results and initial experience of reconstructing defects with NovoSorb® Biodegradable Temporising Matrix (BTM): A UK case series. Eur. J. Plast. Surg. 2023, 46, 1331–1338. [Google Scholar] [CrossRef]
- Wagstaff, M.J.; Schmitt, B.J.; Coghlan, P.; Finkemeyer, J.P.; Caplash, Y.; Greenwood, J.E. A biodegradable polyurethane dermal matrix in reconstruction of free flap donor sites: A pilot study. Eplasty 2015, 15, e13. [Google Scholar] [PubMed]
- Heard, J.; Sen, S.; Greenhalgh, D.; Palmieri, T.; Romanowski, K. Use of Cultured Epithelial Autograft in Conjunction with Biodegradable Temporizing Matrix in Massive Burns: A Case Series. J. Burn. Care Res. 2023, 44, 1434–1439. [Google Scholar] [CrossRef] [PubMed]
- Austin, C.L.; Draper, B.; Larson, K.W.; Thompson, S.J. Biodegradable temporising matrix: Use of negative pressure wound therapy shows a significantly higher success rate. J. Wound Care 2023, 32, 159–166. [Google Scholar] [CrossRef] [PubMed]
- Schmitt, B.; Heath, K.; Kurmis, R.; Klotz, T.; Wagstaff, M.J.D.; Greenwood, J. Early physiotherapy experience with a biodegradable polyurethane dermal substitute: Therapy guidelines for use. Burns 2020, 47, 1074–1083. [Google Scholar] [CrossRef] [PubMed]
- Tyack, Z.; Ziviani, J.; Kimble, R.; Plaza, A.; Jones, A.; Cuttle, L.; Simons, M. Measuring the impact of burn scarring on health-related quality of life: Development and preliminary content validation of the Brisbane Burn Scar Impact Profile (BBSIP) for children and adults. Burns 2015, 41, 1405–1419. [Google Scholar] [CrossRef] [PubMed]
- Simons, M.; Kimble, R.; McPhail, S.; Tyack, Z. The longitudinal validity, reproducibility and responsiveness of the Brisbane Burn Scar Impact Profile (caregiver report for young children version) for measuring health-related quality of life in children with burn scars. Burns 2019, 45, 1792–1809. [Google Scholar] [CrossRef] [PubMed]
- Simons, M.; Kimble, R.; McPhail, S.; Tyack, Z. The Brisbane Burn Scar Impact Profile (child and young person version) for measuring health-related quality of life in children with burn scars: A longitudinal cohort study of reliability, validity and responsiveness. Burns 2019, 45, 1537–1552. [Google Scholar] [CrossRef] [PubMed]
- Cheshire, P.A.; Herson, M.R.; Cleland, H.; Akbarzadeh, S. Artificial dermal templates: A comparative study of NovoSorb™ Biodegradable Temporising Matrix (BTM) and Integra ® Dermal Regeneration Template (DRT). Burns 2016, 42, 1088–1096. [Google Scholar] [CrossRef] [PubMed]
- Crowley, K.; Balaji, S.; Stalewski, H.; Carroll, D.; Mariyappa-Rathnamma, B. Use of Biodegradable Temporizing Matrix (BTM) in large trauma induced soft tissue injury: A two stage repair. J. Pediatr. Surg. Case Rep. 2020, 63, 101652. [Google Scholar] [CrossRef]
- Olsen, T.M.; Ali-Khan, S.; Bell, D. Comparative Analysis of Animal-Derived vs Fully Synthetic Acellular Dermal Matrices in Reconstructive Surgery: An Examination of Clinical, Aesthetic, and Economic Measures. Ann. Plast. Surg. 2024, 92 (Suppl. S2), S172–S178. [Google Scholar] [CrossRef] [PubMed]
Patient | Gender | Age | Condition | Anatomical Site/Indication | Time Interval for Grafting | Complications/Outcome |
---|---|---|---|---|---|---|
P1 | Male | 16 y.o. | RDEB | Bilateral hand release | No grafting | Bilateral good thumb abduction, bilateral maintaining webspaces, bilateral digit contractures |
P2 | Male | 12 y.o. | RDEB Previous bilateral hand release with blister skin graft and FTSG (6, 7 and 9 y.o.) | Right hand release followed by left hand release 2 months later | No grafting | Bilateral thumb adduction, bilateral finger refusion, bilateral finger severe contractures. Re-operation planned in the near future |
P3 | Female | 7 y.o. | RDEB | Bilateral hand release | No grafting Left hand re-operation (8 y.o.) | Post 2nd surgery: left thumb abduction, maintaining left webspaces, remaining left finger contractures |
P4 | Female | 14 y.o. | RDEB Previous left hand debridement and separation of 3rd webspace (9 y.o.) | Left hand release followed by right hand release 14 months later | No grafting | Left first webspace and thumb abduction decrease, left finger webspaces contractures, left finger flexion contractures. Left hand planned for re-operation. Right thumb maintaining abduction, maintaining right finger webspaces, right digit contractures |
P5 | Female | 11 y.o. | RDEB Previous correction of pseudosyndactyly of right index and middle finger and grafting (6 y.o.) | Defect after biopsy of suspected scc in right middle fingertip | No grafting | No OT required, good healing process after BTM application, no malignancy identified |
P6 | Male | 8 y.o. | RDEB | Right ear ulcers: external auditory canal, triangular fossa, scapha | No grafting | No satisfying healing, chronic wounds due to RDEB recurrence |
P7 | Female | 10 y.o. | 60% flame burn when 6 m.o. | Post-burn contracture release in right ankle | BTM and NPWT 28 days: STSG | Ongoing OT for scar care. Satisfying function of right ankle joint |
P8 | Male | 4 y.o. | 93% scald burn when 2 y.o. | Post-burn contracture release in left ankle and then in dorsum of right foot | BTM and NPWT 37 days: STSG in left foot 35 days: STSG in right foot | Ongoing OT, TCA injections, ongoing healing, tight scar in anterior ankles restricting full active ROM, thermoplastic splint |
P9 | Male | 1 y.o. | 3% contact burn | Right palm STSG, contractures release and FTSG, FTSG failure, then BTM | 23 days: STSG and contracture release and splinting 36 days later: further contracture release | Severe finger contractures, ongoing OT and splinting |
P10 | Female | 1 y.o. | 45% scald burn | Bilateral forearms, critical condition, patient unstable for grafting | 30 days: BTM removal due to infection | Ongoing healing, scar management |
P11 | Male | 9 y.o. | Dog bite injury | Right thigh, exposed muscle fascia | BTM and NPWT No grafting 4 × 4 cm defect | OT for scar care |
P12 Figure 1 | Female | 12 y.o. | Avulsion/degloving injury | Ulnar side of left ring finger with exposed digital nerve repaired with interposition vein graft, exposed extensor and flexor tendons | 23 days: FTSG | Tight scars and stiffness of DIP and PIP joints, ongoing splinting and OT |
P13 Figure 2 | Female | 6 y.o. | Friction burn | Dorsum of right hand over MCP joints with exposed extensor tendons | No grafting Cast application | Wounds fully healed, OT for scar management |
P14 | Female | 9 y.o. | Degloving injury | Left lower leg, exposed muscle | BTM and NPWT 25 days: STSG | Wounds healing well, ongoing scar care |
P15 Figure 3 | Female | 10 y.o. | Road traffic accident/degloving injury | Right occipital bone, exposed calvarium | 24 days: STSG 12 days later: re-grafting due to STSG failure | Wound fully healed, ongoing OT and scar care |
P16 | Male | 5 y.o. | Crush injury | Right index finger fasciotomies | No grafting 28 days post-op: haematoma underneath the BTM, treated conservatively | Hypertrophic scar formation, ongoing OT, ulnar deviation at PIP joint due to non-union of middle phalanx fracture |
P17 | Female | 15 y.o. | Friction burn | Left medial elbow scar excision. Previous fasciotomies 32 days ago | BTM and NPWT 35 days: STSG and NPWT | Good healing, ongoing scar care |
P18 | Female | 2 y.o. | Osteomyelitis | Right great toe distal phalanx debridement | No grafting | Wound fully healed, sensation loss due to osteomyelitis |
P19 | Female | 2 d.o. | Unknown infection | Left arm, elbow joint tendons exposed | No grafting | Healing well, complete loss of median, radial and ulnar nerve function/neurolysis, tight left wrist extension, scarring |
P20 | Female | 13 y.o. | Multifocal osteomyelitis, staphylococcal infection | Right medial ankle and leg, joint exposed | BTM and NPWT 40 days: STSG and NPWT | Wound fully healed, right ankle joint stiffness due to osteomyelitis |
P21 | Female | 12 y.o. | Infected pilomatrixoma | Right forearm extensor side, soft tissue defect after debridement | 23 days: STSG and NPWT | Wound healing well, OT for scar management |
P22 Figure 4 | Male | 10 m.o. | Streptococcal A septicaemia, septic embolism | Left forearm amputation, exposed bone. Left leg debridement, exposed muscle | BTM and NPWT 24 days: STSG and NPWT | Wound edges overgranulation, good elbow function, small defects in leg wound, scars not affecting ROM |
P23 | Male | 1 y.o. | Meningococcal septicaemia, septic embolism | Left lower limb amputation above knee, left arm amputation above elbow, exposed bone | BTM and NPWT 42 days: further 1 cm debridement of necrotic humerus, STSG and NPWT 51 days later: revision left arm amputation | Completion of OT sessions, rehabilitation centre |
P24 | Male | 5 y.o. | Necrotising fasciitis after chickenpox | Upper back, trapezius muscle exposed | BTM and NPWT 33 days: STSG and NPWT | Wounds healing well, stable scars, no restriction in movements |
P25 | Female | 5 y.o. | Streptococcal A septicaemia, septic embolism | Anterior shin and dorsum of right foot, exposed tendons | 28 days: STSG and cast | Good mobilization, ongoing OT, serial casting |
P26 | Male | 10 y.o. | Compartment syndrome, extravasation injury | Right forearm volar aspect, exposed muscles after fasciotomies | BTM and NPWT No grafting | OT, scar management, ongoing splinting |
P27 | Male | 1 m.o. | Neonatal ischemia, NICH | Necrotic ulcer in dorsum of left foot, exposed bone | BTM and NPWT 38 days: STSG and NPWT 12 days later: delayed graft failure | Wound epithelialization, splinting to improve foot position |
P28 | Male | 3 y.o. | Streptococcal A septicaemia, septic embolism | Bilateral thigh amputation, exposed bone. Bilateral forearm debridement, exposed muscle | BTM and NPWT in left stump and left forearm 7 days later: BTM in right stump and right upper arm, BTM replacement in left stump and in left forearm due to haematoma underneath. 25 days: STSG and NPWT | Wounds healing well, hypergranulation in right arm, ongoing OT |
P29 | Female | 1 m.o. Pre-term (28 weeks) | Compartment syndrome, extravasation injury | Right forearm amputation below elbow, exposed bone | No grafting | Wound healing well |
P30 | Male | 9 d.o. | Neonatal compartment syndrome | Right forearm fasciotomy, exposed muscle | No grafting 16 months later: contracture release with serial Z-plasty with neurolysis of median nerve and tendon lengthening of FCR and musculotendinous lengthening of FDS | Casting for 2 years, scar contractures in right wrist, intrinsic function of ulnar nerve |
P31 | Female | 1 m.o. Pre-term (24 weeks) | Neonatal ischemia | Forefoot amputation bilaterally | No grafting | Wounds healing well |
P32 | Male | 5 y.o. | Streptococcal A septicaemia, skin necrosis | Right distal forearm and wrist full-thickness skin necrosis | BTM and NPWT No grafting | Ongoing splinting for right little and ring finger, good finger ROM, full ROM in wrist, OT for scar care |
BTM | Integra | |
---|---|---|
Mean surgery time (p = 0.011) | 1.632 ± 0.571 h | 5.282 ± 5.102 h |
Median post-operative hospital stay (p = 0.003) | 0.95 days | 6.60 days |
Median post-operative follow-up visits (p = 0.012) | 5 | 14 |
Median duration for complete wound closure (p = 0.011) | 46.96 days | 118.91 days |
Infection rate (p = 0.022) | 0.0% | 36.4% |
Wound hypertrophy rate (p = 0.015) | 26.7% | 81.8% |
Failed wound closure (p = 0.003) | 6.7% | 26.7% |
Mean profit per square centimetre (p < 0.001) | $10.63 | $22.53 |
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Bini, A.; Ndukwe, M.; Lipede, C.; Vidyadharan, R.; Wilson, Y.; Jester, A. The Role of Biodegradable Temporizing Matrix in Paediatric Reconstructive Surgery. J. Clin. Med. 2025, 14, 5427. https://doi.org/10.3390/jcm14155427
Bini A, Ndukwe M, Lipede C, Vidyadharan R, Wilson Y, Jester A. The Role of Biodegradable Temporizing Matrix in Paediatric Reconstructive Surgery. Journal of Clinical Medicine. 2025; 14(15):5427. https://doi.org/10.3390/jcm14155427
Chicago/Turabian StyleBini, Aikaterini, Michael Ndukwe, Christina Lipede, Ramesh Vidyadharan, Yvonne Wilson, and Andrea Jester. 2025. "The Role of Biodegradable Temporizing Matrix in Paediatric Reconstructive Surgery" Journal of Clinical Medicine 14, no. 15: 5427. https://doi.org/10.3390/jcm14155427
APA StyleBini, A., Ndukwe, M., Lipede, C., Vidyadharan, R., Wilson, Y., & Jester, A. (2025). The Role of Biodegradable Temporizing Matrix in Paediatric Reconstructive Surgery. Journal of Clinical Medicine, 14(15), 5427. https://doi.org/10.3390/jcm14155427