gms | German Medical Science

Introduction: BTM is a totally synthetic dermal replacement scaffold, composed of a 2mm thick, biodegradable polyurethane foam bonded to a non-biodegradable polyurethane film (seal). In 2014, following our pre-clinical and clinical development programme, we were the first unit using BTM in the management of burn injuries, along with developing protocols for its use. We aim to present our outcomes and experiences from the first twenty consecutive burn cases using BTM, along with the evolution of our practice since its adoption.

Materials and methods: Patients and data were identified via our departmental database. Medical records were retrospectively reviewed, with patient demographics and clinical outcomes being collected. Extensive photographs were taken at each intervention for presentation of qualitative learning points.

Results: 75% of patients were male (n=15) with an age range of 17-94 years, representing total body surface area burn range of 5-75% (mean 33.9% full thickness). Mean %TBSA BTM application was 30.8. Mean time from admission to completion of BTM application was 5 days (± SD=7) for upper limb sites and 10 days (± SD= 11) for lower limb sites. Mean time from application of BTM to completion of grafting was 36 days. Mean length of stay was 99.5 days. Complication rates including BTM loss and graft loss will be presented. Reasons for BTM loss include seroma/haematoma, infection/contamination, early loss of seal due to shear, and failure to integrate due to fat necrosis beneath the dermal substitute.

Conclusion: We have experienced a significant learning curve and increased confidence over time with the use of BTM, finding it safe and effective as a dermal substitute – persisting in the presence of infection and resulting in qualitatively favourable scar outcomes. We have integrated it into our routine management of extensive burns and complex wounds.