Top 9 Questions about Using NovoSorb BTM in a Clinical Setting

1. Can NovoSorb BTM Be Applied with a Graft in a One-Stage Procedure?

NovoSorb BTM is applied in a single application, providing temporary wound closure while the open cell porous matrix acts as a scaffold for tissue ingrowth. NovoSorb BTM is a two-stage procedure, as it requires the tissue to be fully integrated throughout the matrix for the sealing membrane to be removed for definitive closure.

A two-stage procedure allows clinicians to graft with confidence as they determine when the tissue is fully integrated for delamination and take back control, as they may graft in stages or all at once,[1] allowing time for donor site regrowth and management of patient comorbidities to lessen bodily stress. As long as the sealing membrane is attached, there is no increased risk of wound contracture if grafting is delayed.[2]

BTMStages_ConferenceImage

2. What Type of Dressings Should Be Used with NovoSorb BTM?

Dressing selections over NovoSorb BTM are according to standard of care, except when they are specifically recommended against.

Outer dressings should:

Have non-adherent properties against the sealing membrane
Absorb mild exudate
Maintain apposition with the wound bed
Minimize shearing forces

Outer dressings may:

Be applied around limbs, compressed with crepe bandages
Contain antimicrobial properties (silver dressings)
Include splints over mobile areas to reduce movement

Note:

Silver dressings may leave a black appearance on the surface
Negative pressure wound therapy (NPWT) may be applied at the surgeon’s discretion.

3. How Frequently Do Dressings Need to Be Changed?

NovoSorb BTM is a synthetic implant and does not contain intrinsic antimicrobial properties. Outer dressings applied over NovoSorb BTM should be changed according to their standard of care, regularly, or when exudate strike-through is noted to ensure NovoSorb BTM stays clean. Dressing changes should not exceed seven days so that integration may be monitored. Splints may also be used to reduce movement in mobile areas where NovoSorb BTM is applied and can be discontinued seven days after placement.

4. Can NovoSorb BTM Be Used with Negative Pressure Wound Therapy (NPWT)?

NPWT is permitted for application at the surgeon’s discretion and should be in accordance with the manufacturer’s guidelines. PolyNovo advises against NPWT instillation techniques that may prevent cellular ingrowth by repeatedly flushing out cellular material within the matrix.

Clinical publications highlight the effective use of NovoSorb BTM in conjunction with NPWT[3]^,[4]^,[5] using a continuous low-pressure setting, including ranges of 50–120 mmHg. Avoid NPWT pressure settings that may overcompress NovoSorb BTM, potentially affecting integration to the wound bed.

When clinicians use NPWT over NovoSorb BTM, PolyNovo recommends the NPWT foam dressing cover the entire NovoSorb BTM and advises against the NPWT adhesive film seal making direct contact with NovoSorb BTM’s sealing membrane.

5. When Can Patients Be Mobilized & Begin Rehabilitation?

Mobilization and range of motion (ROM) activities should be performed once NovoSorb BTM adheres to the wound bed, approximately one to two weeks after application. Mobilization and ROM exercises can safely occur earlier during the integration phase if they do not cause shearing of the matrix.

With increasing use of dermal substitutes, clinical protocols and guidelines are pending development to standardize patient care. In a recently published article,[6] authors Brad Schmitt et al. aimed to draw on early experience with NovoSorb BTM to develop mobilization and ROM guidelines for therapy treatment. The study concluded early ROM achieved at NovoSorb BTM delamination with continued improvement post-SSG application. Scar assessments indicated good cosmetic outcomes with no adverse events linked to physiotherapy treatment. After close monitoring and experience with NovoSorb BTM grew, active mobilization and ROM was commenced earlier at ~7 days post-NovoSorb BTM application, when NovoSorb BTM is adhered to the wound bed.

6. How Should NovoSorb BTM Be Applied & Positioned to the Wound Bed?

Once the wound bed is cleaned and thoroughly debrided, surgeons can create a template by pressing the NovoSorb BTM against the wound bed. From there, they can cut the NovoSorb BTM to fit the shape of the wound, apply NovoSorb BTM with the matrix side facing down, and affix with sutures/staples. NovoSorb BTM’s edges should be flush against the wound sides and each NovoSorb BTM sheet used.

7. How Do You Identify & Manage a Hematoma?

A collection of turbid fluid, or a hematoma, can be identified by its appearance through NovoSorb BTM’s sealing membrane and possible lifting of the matrix away from the wound bed. If there is a hematoma under the sealing membrane or within the matrix, the sealing membrane’s existing fenestrations or a small incision can allow drainage, removing the collection to achieve hemostasis. Once resolved, ensure NovoSorb BTM is readhered to the wound bed for integration to progress.

Collections during early-stage integration can impact the initial adherence of NovoSorb BTM with the wound bed. Partial or total removal and replacement of NovoSorb BTM may be required if integration is not progressing after expression. Collections that develop after NovoSorb BTM has adhered to the wound bed can push the sealing membrane away from the integrating matrix, resulting in early delamination.

8. Can NovoSorb BTM Be Removed and Replaced if Necessary?

Most localized infections and fluid collections (e.g., hematomas) can be carefully monitored and managed while keeping NovoSorb BTM in place, not necessarily requiring removal of the matrix. However, if the pus, discharge, or fluid collection is unmanageable with NovoSorb BTM in place and interferes with the matrix adherence to the wound bed, the NovoSorb BTM can be removed and replaced after the wound has been cleaned.

9. How Many Sutures or Staples Should Be Used?

The number of sutures and staples required should be enough to ensure good adherence to the wound bed. Where possible, quilting staples applied across the wound bed are encouraged to ensure good adhesion of NovoSorb BTM to the wound bed and avoid tenting of the NovoSorb BTM.

If you’re a surgeon exploring your options for treating severe skin trauma and other complex wounds, be sure to consider the benefits of NovoSorb BTM. To learn how NovoSorb BTM’s patented NovoSorb polymers can promote regenerative healing with long-lasting successful outcomes and other substantial benefits for both patients and physicians, reach out to our team of experts today at (302) 268-6163.

Note: this document contains general guidelines and is not designed to replace existing institutional protocols or professional clinical judgment regarding patient care. Please refer to the instructions for use.

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[1] Greenwood JE, Schmitt BJ, Wagstaff MJD. Experience with a synthetic bilayer Biodegradable Temporizing Matrix in significant burn injury. Burns Open. 2018;2(1):17–34.

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

[3] Solanki NS, York B, Gao Y, Baker P, Wong She RB. A consecutive case series of defects reconstructed using NovoSorb® Biodegradable Temporizing Matrix: Initial experience and early results. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2020; 73(10):1845–3.

[4] Wagstaff MJD, Slana IM, Caplash Y, Greenwood JE. Biodegradable temporizing Matrix (BTM) for the reconstruction of defects following serial debridement for necrotizing fasciitis: A case series. Burns Open. 2019; 3:12-30.

[5] Crowley K, Balaji S, Stalewski H, Carroll D, Mariyappa-Rathnamma B. Use of Biodegradable Temporizing Matrix (BTM) in large trauma induced soft tissue injury: A two stage repair. Journal of Pediatric Surgery Case Reports. 2020; 63:101652.

[6] Schmitt B, Heath K, Kurmis R, Klotz T, Wagstaff MJ, Greenwood J. Early physiotherapy experience with a biodegradable polyurethane dermal substitute: Therapy guidelines for use. Burns, 2020.