NovoSorb® Biodegradable Temporizing Matrix (BTM): what we learned from the first 300 consecutive cases

Introduction Extensive full-thickness soft-tissue defects remain a challenge in reconstructive surgery. NovoSorb® Biodegradable Temporising Matrix (BTM) represents a novel dermal substitute and was evaluated in wounds deriving from different aetiologies and to highlight risk factors for poor take rates. Methods All patients treated with BTM at our department between March 2020 and October 2022 were included. Differences in univariate and linear regression models identified predictors and risk factors for take rates of BTM and split-thickness skin grafts (STSG). Results Three hundred patients (mean age 54.2±20.1 years, 66.3% male, 59.7% burns, 19.7% trauma, 20.6% others) were evaluated. Mean take rates of BTM and STSG after BTM delamination were 82.7±25.2% and 86.0±22.6%. Multiple regression analyses showed that higher body mass index (BMI,OR-0.43,95%CI-0.86,-0.01,p=0.44), prior allograft transplantation (OR-15.12,95%CI-26.98,-3.31,p=0.041), longer trauma-to-BTM-application intervals (OR-0.01,95%CI-0.001,-0.001,p=0.038), positive wound swabs before BTM (OR-7.15,95%CI-13.50,-0.80,p=0.028), and peripheral artery disease (OR-10.80,95%CI-18.63,-2.96,p=0.007) were associated with poorer BTM take. Higher BMI (OR-0.40,95%CI-0.76,-0.08,p=0.026), increasing BTM graft surface areas (OR-0.58,95%CI -1.00,-0.17,p=0.005), prior allograft (OR-12.20,95%CI -21.99, -2.41, p=0.015) or autograft transplantations (OR-22.42,95%CI-38.69,-6.14,p=0.001), tumour as the aetiology of the wound (OR-37.42,95%CI-57.41,-17.83,p=0.001) diabetes (OR-6.64,95%CI-12.80,-0.48,p=0.035), and impaired kidney function (OR-5.90,95%CI-10.94,-0.86,p=0.021) were associated with poorer STSG take after delamination of BTM, whereas higher BTM take rates were associated with better STSG take (OR0.40,95%CI0.31,0.50,p<0.001). Conclusion Extensive complex wounds of different aetiologies unsuitable for immediate STSG can be successfully reconstructed by means of two-staged BTM-application und subsequent skin grafting. Importantly, presence of wound contamination or infection and prior allograft coverage appear to jeopardize good BTM and STSG take.