RESUMEN
Skin and soft tissue reconstruction has long been based on the reconstructive ladder. However, a skin substitute has become popular due to its predictable outcomes, without donor-site morbidity. The biodegradable temporizing matrix (BTM; NovoSorb, PolyNovo Ltd., Port Melbourne, Australia) is a synthetic skin substitute that has recently gained its clinical application. Compared with those of other dermal templates, the clinical efficacy and performance of the BTM are not well established, especially among the Asian population. This study aims to share our experience and strategy of using BTM in various wound conditions. The data of patients who underwent skin and soft tissue reconstruction with BTM at a single institution between January 2022 and December 2023 were reviewed. The patient demographics, wound characteristics, surgical details, secondary procedures, and complications were recorded and analyzed. Postoperative 6-month photographs were collected and independently evaluated by two plastic surgeons and two wound care center nurses using the Manchester Scar Scale (MSS). This study included 37 patients, consisting of 22 males and 15 females with a mean age of 51.8 years (range, 18-86 years old). The wound etiologies included trauma (67.6%), necrotizing soft tissue infection (16.2%), burns (10.8%), toe gangrene (2.7%), and scar excision (2.7%). The average wound area covered by BTM was 50.6 ± 47.6 cm2. Among the patients, eight received concomitant flap surgery and BTM implantation, 20 (54.1%) underwent subsequent split-thickness skin grafts (STSG), and 17 had small wounds (mean: 21.6 cm2) healed by secondary intention. Infection was the most common complication, affecting six patients (n = 6 [16.2%]), five of whom were treated conservatively, and only one required debridement. Thirty-three patients (89.2%) had good BTM take, and only four had BTM failure, requiring further reconstruction. At the last follow-up, 35 out of the 37 patients (94.6%) achieved successful wound closure, and the total MSS score was 10.44 ± 2.94, indicating a satisfactory scar condition. The patients who underwent BTM grafting without STSG had better scar scores than those who received STSG (8.71 ± 2.60 vs. 11.18 ± 2.84, p = 0.039). In conclusion, the BTM is effective and feasible in treating various wounds, with relatively low complication rates, and it can thus be considered as an alternative for skin and soft tissue reconstruction. When combined with adipofasical flap reconstruction, it achieves a more comprehensive anatomical restoration.
RESUMEN
BACKGROUND: Functional recovery following peripheral nerve injury worsens with increasing time of denervation prior to repair. Denervated muscle undergoes progressive atrophy that limits the extent to which motor end plates can be reinnervated. The aim of this study is to assess nerve injuries reconstructed at different time points, and identify various neural and muscle-based markers to predict functional outcome, including an in-depth look at the neuromuscular junction. MATERIAL AND METHODS: Adult wild type C57BL/6J mice received surgery on the sciatic nerve and were divided into five groups: 1) Nerve cut and repaired, 2) Acute: nerve cut and immediately repaired with 1cm autograft, 3) Subacute: nerve grafted two weeks after injury, 4) Delayed (D): nerve grafted four weeks after injury, 5) Nerve cut and capped. Functional recovery was measured by treadmill and electrodiagnostic tests. Nerves were harvested for histology evaluation, and leg muscles for histology evaluation and NMJ immunofluorescent staining of motor end plate innervation and terminal Schwann cells (tSC). RESULTS: Delayed graft group performed worst in nearly all parameters. Subacute graft group shared more similarities with the acute group, especially the tSC response (Subacute 48% vs Acute 51%) and motor end plate innervation pattern (Subacute 75% vs Acute 72%). Only parameters to elucidate differences were muscle weight and motor end plate fragmentation. Traditional axon count failed to capture differences between the three groups. CONCLUSION: tSC activity and NMJ innervation pattern can be used as predictive markers of functional recovery that captures differences between acute, subacute and delayed nerve injuries.