NovoSorb® BTM (Biodegradable Temporizing Matrix) is a biocompatible device designed to temporize dermal injuries where tissue has been decimated or lost and to facilitate dermal repair by providing temporary wound closure and a scaffold for the generation of new dermal tissue. NovoSorb BTM is intended for single application and shouldn’t be applied into overtly infected wounds.

NovoSorb BTM compartmentalizes a large wound into a series of interconnected microwounds to promote organized regenerative healing. Below, we outline the key steps for treating patients with NovoSorb BTM.

1. Preparation

NovoSorb BTM is designed to integrate over a wound bed consisting of viable tissue: dermis, subcutaneous fat, muscle, paratenon, periosteum, etc. NovoSorb BTM may bridge avascular structures, such as bone or tendon,[1] if the matrix is in contact with adequate viable tissue surrounding the structure. Application over exposed bone may require the bone to be burred or drilled to induce punctate bleeding.[2]  

In preparing the wound bed for NovoSorb BTM application, all nonviable tissue should be completely excised (i.e., debridement).

– Clean and debride the wound
– Ensure the wound is free of infection
– Make sure effective hemostasis has been achieved

2. Application

NovoSorb BTM is ready for application straight from the packaging with no further preparation typically required. NovoSorb BTM’s sealing membrane is supplied prefenestrated to allow drainage of excess fluid. For wound beds expected to be highly exudative, further fenestrations may be applied with a scalpel.

To apply NovoSorb BTM:

– Create a template by pressing the matrix against the freshly debrided wound or by using a surgical pen to mark the wound edges to guide the shape of the wound.
– Simply cut and trim to fit the shape of the wound bed and apply with the sealing membrane facing externally.
– Ensure the matrix is in contact with the wound bed, with good apposition of the wound edges and adjacent sheets.
– Affix NovoSorb BTM in place with sutures and/or staples, applying quite taut with quilting staples over joints or large areas to help maintain contact with the wound bed and to account for swelling to subside.

3. Outer Dressings & Wound Care

Dressing selections over NovoSorb BTM should be according to standard of care, except when recommended against. The timing of dressing changes is according to standard of care but shouldn’t exceed 7 days so the wound can be closely monitored and any observations that may arise can be managed as needed (e.g., infection, fluid collections, etc.).

Apply dressings over NovoSorb BTM that:

– Are nonadherent against the sealing membrane
– Absorb mild exudate
– Maintain NovoSorb BTM in apposition with the wound bed
– Possess an antimicrobial property
– Encourage continued contact of NovoSorb BTM to the wound bed
– Minimize shearing forces to the NovoSorb BTM

Apply as required:

– Around limbs, compression may be applied with crepe bandages
– Dressings may contain antimicrobial properties (such as silver dressings)
– Splints over mobile areas may be used to reduce movement
– Negative pressure wound therapy (NPWT)

Monitor progress:

– Clean NovoSorb BTM by gently wiping the surface with a saline gauze and/or an antimicrobial solution
– Change dressings if strike-through of exudate is evident
– Replace antimicrobial dressings as per your dressing protocol
– Leave sutures/staples in place until the sealing membrane is delaminated
– Avoid shearing or lifting the matrix from the wound bed during dressing changes

Assess:

– Degree of integration
– Excess exudate and purulence
– Presence of any localized infections
– Presence of a hematoma

Address clinical events:

– Express excess fluid collections or localized infections through fenestrations, the holes from quilting stapes, or from NovoSorb BTM’s edges

4. Assessing Tissue Integration

Cellular migration enables collagen production and neovascularization throughout the matrix. As NovoSorb BTM integrates with the wound, its appearance will change over time. Integration time depends on patient and wound factors.

During weeks 1 and 2:

– NovoSorb BTM matrix is visible through the clear sealing membrane.
– NovoSorb BTM is dark red in color due to the ingress of blood from the wound.
– NovoSorb BTM gradually changes to a lighter red color during integration.
– Areas where NovoSorb BTM isn’t against the wound (tenting) may be readhered to the wound bed.
– Collections of turbid fluid or hematomas under the seal can be expressed via the fenestrations in the overlying seal.
– Once NovoSorb BTM has adhered to the wound bed, gentle range of motion exercises can begin.
– By the end of week 2, signs of integration should be visible.

During weeks 3 through 6:

– The matrix cell architecture and patterns seen initially through the seal are gradually obliterated as the NovoSorb BTM further integrates.
– Later during this time period, capillary refill (blanching) may be observed by applying digital pressure to the sealing membrane.
– When the matrix cells are no longer visible, there is capillary refill, and the matrix is a uniform pink color, then the NovoSorb BTM is ready for delamination when clinically indicated (see Step 5 below).

Note: The use of certain dressings containing silver may leave a black tarnished appearance on the surface of the NovoSorb BTM.

5. Delamination

Delamination should be performed once the slowest area has integrated and involves the following steps:

– Remove all staples and/or sutures.
– Using forceps, raise a free edge of the sealing membrane.
– Peel the membrane off the matrix using gentle, even traction.
– Any unintegrated matrix fragments will pull away with the seal. However, integrated NovoSorb BTM will remain firmly adhered to the wound bed.
– The integrated and delaminated NovoSorb BTM can be closed or dressed according to the clinician’s choice for the patient.

6. Definitive Closure

After delamination, the neodermis may be refreshed before definitive closure.

Definitive closure is at the discretion of the surgeon, using methods such as:

– Split-thickness skin graft
– Full-thickness skin graft
– Cultured epithelial autograft
– Re-epithelialization by secondary intention

If using skin grafts:

– Prepare the skin graft for closure following standard protocol.
– A mild refresher to the surface may be considered (e.g., dermabrasion or hydrosurgery).
– Skin grafts can be applied and dressed according to standard of care.

NovoSorb BTM is a synthetic biodegradable temporizing dermal matrix that can be used to treat a variety of traumatic wounds. To learn more about the benefits of NovoSorb BTM and how its patented NovoSorb® technology promotes regenerative healing, visit our website or contact one of our knowledgeable team members at (302) 268-6163.

References:

[1] Damkat-Thomas L, Greenwood JE, Wagstaff MJD. A synthetic Biodegradable Temporising Matrix in degloving lower extremity trauma reconstruction: A case report. PRS – Global Open. 2019; 7(4):e2110.

[2] Greenwood JE, Wagstaff MJD, Rooke M, Caplash Y. Reconstruction of extensive calvarial exposure after major burn injury in 2 stages using a biodegradable polyurethane matrix. Eplasty. 2016; 16:151-60.