Application of Novosorb biodegradable temporising matrix in wounds of different aetiologies: a case series
Abstract
This case study series outlines the use of Novosorb biodegradable temporising matrix (BTM, PolyNovo, Australia) in the management of 22 patients, each with a complex wound who attended the vascular department in the University Hospital Limerick between 2021 and 2023. The majority of patients presented with acute conditions (e.g. necrotising fasciitis, crush injuries, compartment syndrome) that initially required high dependency level care. The majority of wounds (21/22, 95%) affected the leg or foot, and one wound was on the chest wall. Each patient had a significant complex wound and, in many cases, was complicated further by the patients’ medical condition and comorbidities, which had the potential to cause problematic and delayed healing. The BTM was applied following debridement, as required, and provided a stable base for secondary wound healing or skin grafting, as needed. Of the patients: 12 (54%) healed completely; one (4%) progressed towards complete vascularisation with the BTM in situ; two (9%) underwent major amputations despite successful application of the BTM to lower limb wounds; and one (4%) returned to theatre to have retained clips removed. The remaining six (27%) patients failed to heal completely following BTM application. Ischaemia, infection, vasculitis and underlying osteomyelitis were limiting factors in achieving limb salvage or healing.
Dermal skin substitutes are an advanced wound therapy used as a temporary or permanent wound cover1 for complex or non-healing wounds, either as a stand-alone treatment or in combination with plastic surgery procedures. They have a number of beneficial actions to promoting wound healing, including through protection from fluid loss and infection. They also provide a scaffold for cell proliferation, promoting cytokine and growth factor production, and reduce scar tissue.2 Examples, in addition to Novosorb (Polynovo, Australia) include Integra (Integra Life Sciences, US) and Dermacell (Life Net Health, US), among others.
This case series describes the use of a biodegradable temporising dermal matrix (BTM) (Novosorb) (Fig 1) in the management of a number of complex wounds of various aetiologies in patients that presented to the vascular department of the University Hospital Limerick between 2021 and 2023. All patients who attended the vascular service and underwent application of the BTM during this period (n=22; Patients 15 and 20 refer to the same patient who underwent their first procedure in 2022 and a second procedure in 2023) were included in this case series report. Wound aetiologies included; crush injuries (n=2); peripheral arterial disease (PAD) (n=5), pressure ulcers (PUs) in patients with diabetes (n=3), PU (n=1), patients post complex haematoma evacuation (n=3), post-excision of squamous cell carcinoma (SSC) (n=1), vasculitis (n=1), fasciotomy (n=1), wounds following debridement for necrotising fasciitis (NF) (n=4), and cavity wound post radiotherapy and arterial bleed (n=1). Table 1 describes the patient demographics and comorbidities. Patients’ ages ranged from 30–95 years, and 16 (73%) of the cohort were male and six (27%) were female.
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