Dr. Michael A. J. Rooke¹, A/Prof. John. E. Greenwood², Mr. Marcus J. D. Wagstaff³

¹ Adult Burns Service, Royal Adelaide Hospital, North Tce. Adelaide, SA, 5000, rooke.michael@gmail.com
² Adult Burns Service, Royal Adelaide Hospital, North Tce. Adelaide, SA, 5000, john.greenwood@sa.gov.au
³ Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, North Tce. Adelaide, 5000, marcus.wagstaff@health.sa.gov.au

In this case report we present our findings related to the use of Biodegradable Temporising Matrix (BTM) for the coverage and preservation of bony structures in a patient with significant burns. Mr TL, a 66-year-old male, sustained 75% TBSA flame burns in November 2015. Among his injuries were significant burns of both upper limbs, with exposure of the metacarpals and olecranon of his left arm and complete loss of his right arm below the elbow. In order to preserve length and facilitate future rehabilitation, after a period of conservative management (three months) these bony defects were debrided down to healthy, granulating bone. To these defects a combination of BTM and secondary skin grafting was applied to cover his exposed bone, thereby providing skin coverage and preserving limb length.

Traditionally injuries such as these would have necessitated either amputation due to a lack of soft-tissue coverage or reconstruction with dermal substitutes. The choice between these two options is often dictated by concerns such as the patient’s physiological state and the absence of multi-resistant organisms.  The above patient suffered from significant medical issues throughout the period prior to grafting (ARDS, Septicaemia) and was colonised with multi-resistant pseudomonas; factors which would normally preclude a staged reconstruction for this patient. BTM is a novel polymer which is easy to apply, can be used to quickly provide reliable coverage of large defects in unwell patients and is resistant to infection. It therefore opens up new options in reconstruction for major burns patients with exposed bone.

Key Words

Reconstruction, Biodegradable Temporising Matrix, Surgery

Biography

Dr. Rooke is the current Burns Registrar for the Adult Burns Service at the Royal Adelaide Hospital.