皮肤和软组织重建长期以来一直基于重建阶梯。然而,皮肤替代品由于其可预测的结果而变得流行,没有供体部位的发病率。可生物降解的临时基质(BTM;NovoSorb,PolyNovoLtd.,墨尔本港,澳大利亚)是一种合成皮肤替代品,最近获得了临床应用。与其他真皮模板相比,BTM的临床疗效和性能还没有得到很好的证实,尤其是亚洲人口。本研究旨在分享我们在各种伤口条件下使用BTM的经验和策略。对2022年1月至2023年12月在单一机构接受BTM皮肤和软组织重建的患者的数据进行了回顾。病人的人口统计,伤口特征,手术细节,次要程序,记录并分析并发症。收集术后6个月的照片,并由两名整形外科医生和两名伤口护理中心护士使用曼彻斯特疤痕量表(MSS)进行独立评估。这项研究包括37名患者,由22名男性和15名女性组成,平均年龄为51.8岁(范围,18-86岁)。伤口病因包括外伤(67.6%),坏死性软组织感染(16.2%),烧伤(10.8%),脚趾坏疽(2.7%),和瘢痕切除(2.7%)。BTM覆盖的平均伤口面积为50.6±47.6cm2。在患者中,8人同时接受皮瓣手术和BTM植入,20例(54.1%)接受了随后的分层厚度皮肤移植(STSG),17例的小伤口(平均:21.6cm2)通过次要意图治愈。感染是最常见的并发症,影响6名患者(n=6[16.2%]),其中五人受到保守治疗,只有一个需要清创术。33例患者(89.2%)服用BTM良好,只有四个人发生了BTM故障,需要进一步重建。在最后一次随访中,37例患者中有35例(94.6%)成功闭合伤口,MSS总分为10.44±2.94,瘢痕情况令人满意。未接受STSG的BTM移植患者的瘢痕评分优于接受STSG的患者(8.71±2.60vs.11.18±2.84,p=0.039)。总之,BTM在治疗各种伤口方面是有效和可行的,并发症发生率相对较低,因此,它可以被认为是皮肤和软组织重建的替代方案。当结合脂肪皮瓣重建时,它实现了更全面的解剖恢复。
Skin and soft tissue reconstruction has long been based on the reconstructive ladder. However, a skin substitute has become popular due to its predictable outcomes, without donor-site morbidity. The biodegradable temporizing matrix (BTM; NovoSorb, PolyNovo Ltd., Port Melbourne, Australia) is a synthetic skin substitute that has recently gained its clinical application. Compared with those of other dermal templates, the clinical efficacy and performance of the BTM are not well established, especially among the Asian population. This study aims to share our experience and strategy of using BTM in various wound conditions. The data of patients who underwent skin and soft tissue reconstruction with BTM at a single institution between January 2022 and December 2023 were reviewed. The patient demographics, wound characteristics, surgical details, secondary procedures, and complications were recorded and analyzed. Postoperative 6-month photographs were collected and independently evaluated by two plastic surgeons and two wound care center nurses using the Manchester Scar Scale (MSS). This study included 37 patients, consisting of 22 males and 15 females with a mean age of 51.8 years (range, 18-86 years old). The wound etiologies included trauma (67.6%), necrotizing soft tissue infection (16.2%), burns (10.8%), toe gangrene (2.7%), and scar excision (2.7%). The average wound area covered by BTM was 50.6 ± 47.6 cm2. Among the patients, eight received concomitant flap surgery and BTM implantation, 20 (54.1%) underwent subsequent split-thickness skin grafts (STSG), and 17 had small wounds (mean: 21.6 cm2) healed by secondary intention. Infection was the most common complication, affecting six patients (n = 6 [16.2%]), five of whom were treated conservatively, and only one required debridement. Thirty-three patients (89.2%) had good BTM take, and only four had BTM failure, requiring further reconstruction. At the last follow-up, 35 out of the 37 patients (94.6%) achieved successful wound closure, and the total MSS score was 10.44 ± 2.94, indicating a satisfactory scar condition. The patients who underwent BTM grafting without STSG had better scar scores than those who received STSG (8.71 ± 2.60 vs. 11.18 ± 2.84, p = 0.039). In conclusion, the BTM is effective and feasible in treating various wounds, with relatively low complication rates, and it can thus be considered as an alternative for skin and soft tissue reconstruction. When combined with adipofasical flap reconstruction, it achieves a more comprehensive anatomical restoration.