gms | German Medical Science

Introduction: Following radical debridement of necrotising fasccitis or complex wound to achieve wound control, cases are frequently managed on burns units as they require complex reconstructions. When skin grafts are used, their contraction can result in contracture of joints, or the neck. On the other hand, reconstruction over exposed bone or vessels using tissue flaps can be bulky, with poor contour definition. Healing of both acute reconstructions, and their donor sites, can be challenging in the physiologically unstable patient. We present our experience of use of BTM as a temporising dermal substitute in seven consecutive cases of necrotising fasciitis and other complex wound scenarios.

Methods: All cases in which BTM has been employed in necrotising fasciitis wound reconstruction have been included. Medical records and operation notes were reviewed retrospectively, including clinical photographs. Photographs were taken of all wounds at each surgery and dressing change. The data collected included demographics, length of stay in hospital, description of defect following serial debridement, indication for BTM, time from implantation to split skin grafting and complications.

We also present cases illustrating the benefits of BTM in complex wounds including traumatic wounds of the lower limb exposing bones, joints and tendons stripped of paratenon; and its limitations such as use over exposed, irradiated, calvarium.

Results: The necrotising fasciitis cohort includes anterior neck defects exposing major vessels (2/7), multiple exposed ribs on the chest wall (2/7), lower limbs crossing knee or ankle joints (3/7) and a lower limb amputation by hip disarticulation (1/7). The mean age was 58 years (31 to 88 years), and the male to female ratio = 3:4. The median inpatient bed days from first debridement to discharge following split skin graft take was 62 days. No BTM was lost and no graft was lost over integrated BTM.

Conclusion: This is the first series of the use of a completely synthetic dermal substitute in necrotising fasciitis wounds. Our data supports previous published evidence that temporising with a dermal substitute is a viable reconstructive option in necrotising fasciitis defects. It is also beneficial in deep and complex traumatic wounds in covering non vital structures such as bone and tendon, as an alternative to vascularised flap or biological dermal substitute reconstruction. It is an inert synthetic scaffold containing no growth factors or bacterial substrates. It is therefore indifferent to the presence of underlying wound infection, however it will also fail to integrate on extensively non-vascularised or irradiated wounds.