Long-term scarring outcomes and safety of patients treated with NovoSorbⓇ Biodegradable Temporizing Matrix (BTM): An observational cohort study.

Background/Aim: NovoSorbⓇ Biodegradable Temporizing Matrix (BTM) is a relatively novel, biodegradable polyurethane-based dermal regeneration template. The aim of this study was to evaluate the long-term scarring outcomes and safety of BTM in patients who underwent dermal reconstruction involving ≥5% of the total body surface area. Methods: This was a postmarket, multicenter, observational cohort study involving evaluation of long-term outcomes in patients treated with BTM. A total of 55 patients (35 from Royal Adelaide Hospital, South Australia, and 20 from Victoria Adult Burns Service, The Alfred, Victoria) who underwent dermal repair with BTM between 2011 and 2017 were screened for inclusion in this study. All patients had BTM implanted for ≥18 months. Results: Fifteen eligible patients with a mean (SD) age of 49.1 (14.3) years completed study assessments. These patients had a total of 39 areas treated with BTM. Using the Patient and Observer Scar Assessment Scale, scar quality was reported to be good by both observers and patients, with a mean (SD) observer score across all lesions of 3.6 (1.2) and mean (SD) overall opinion of 3.8 (1.2) as well as a mean (SD) patient score of 3.5 (1.2) and overall opinion of 5.0 (2.2). No adverse events or adverse device effects were reported or identified. Conclusion: The long-term scar quality is comparable to published studies. BTM is safe in the long term with no additional risks or adverse consequences being identified.

Analysis of the increasing prevalence of necrotising fasciitis referrals to a regional plastic surgery unit: a retrospective case series.

Necrotising Fasciitis is a destructive infection of the skin and subcutaneous tissues associated with significant mortality and morbidity. Survival from the condition often necessitates patient referral for appropriate reconstructive surgery and supportive medical management. The aim of our study was to identify emerging patterns, characteristics and outcomes of necrotising fasciitis in Northern Ireland. A retrospective analysis of all patients referred to the Regional Plastic Surgery Service in Belfast between 2007 and 2012 was performed. Forty-six patients were identified with clinical, intraoperative and histopathological confirmation of necrotising fasciitis. Mean patient age was 59.4 years (range 32-88) with a 25:21 male to female ratio. 13 patients died from the disease. Smoking, obesity, diabetes and immunocompromise were the most prevalent co-morbidities identified. 37 patients had no identifiable mechanism of infection initiation in the history. Painful cellulitis (44/46), skin necrosis (26/46), skin blistering (8/46) and subcutaneous emphysema (3/46) were the most common presenting features. The median LRINEC score at presentation was 7 (range 2-12). The mean serum lactate at presentation was 4.0 mmol/L (range 1.6-13.5). LRINEC scores and serum lactate at presentation exhibited diagnostic sensitivities of 65% and 90% respectively. The lower extremity was the most commonly affected anatomical site (16/46). Group A Streptococcus was the most frequently isolated causative bacterium from debrided tissue cultures (16/46). The prevalence of necrotising fasciitis in the population studied is increasing, particularly in relation to patient cases caused by Group A Streptococcal infection. Increasing bacterial virulence and levels of patient immunocompromise may explain this increasing trend. The LRINEC scoring system lacked diagnostic sensitivity. Elevated serum lactate was supported as both a diagnostic and prognostic indicator. The findings of our study are somewhat limited in their application to other regions and highlight the need for a national analysis of necrotising fasciitis in the UK.

Fibromatosis of the flexor pollicus longus tendon.

An unusual case of fibromatosis of the dominant left flexor pollicus longus (FPL) in a thirteen year old schoolboy. Initially presenting with pain in the thenar eminence and difficulty flexing the metacarpal phalangeal joint (MPJ), other symptoms include locking, triggering and difficulty writing. MRI showed a 4cm segment of thickened abnormal tendon. Intra-operatively three 1cm nodules were excised from the FPL while preserving the tendon. Histopathology reported the nodules as fibromatosis. A literature search revealed that this has not previously been reported although symptomatic tendon sheath fibromas have. Our patient achieved a good result following surgical intervention and the two year review has shown no complications.