Traumatic Abrasion

15 Jul 2022

Case Report

Hospital University Medical Center, New Orleans, LA

NovoSorb® BTM was used to successfully close a large wound on a compromised patient after failure of a meshed bovine dermal matrix.

A male patient sustained a 44% Total Body Surface Area (TBSA) tissue deficit from an abrasion trauma. The injured area included his posterior torso and other locations. The patient had multiple comorbidities, which limited reconstructive options and increased wound care risks. NovoSorb BTM was selected as the most suitable option for treatment after failure of a biological dermal matrix.

Figure 1: Initial presentation; injuries to the posterior torso.

Figure 2: 9 days post initial excision; exposed muscle, fascia, and bone.

Figure 3: 5 days post biological dermal application; meshed bovine matrix failed to incorporate and was removed.

Figure 4: 4 days post NovoSorb BTM application; hematomas noted with early vascularization.

Figure 5: 7 months post injury date; smooth and pliable skin with minimal scarring.

    Background

    A 44-year-old African American male sustained a traumatic abrasion to his posterior torso (Fig. 1) and other locations after being hit and dragged underneath a moving vehicle for an unknown distance.

    The patient had multiple comorbidities including HIV, alcohol-induced chronic pancreatitis, polysubstance abuse, and poorly controlled diabetes which limited reconstructive options and increased wound care risks. NovoSorb BTM was selected as the most suitable option for treatment after failure of a biological dermal matrix.

    Reconstructive options included the excision and debridement of necrotic tissue followed by conservative wound care with risks of infection, sepsis, death, and/or hospice. Local flap coverage for exposed bone was discussed with the plastic surgery team but ultimately rejected due to the patient’s comorbidities and injuries that extended into muscle. After a thorough discussion with the clinical team and the patient’s family, it was decided to remove all necrotic tissue and attempt wound closure initially with the help of a biological dermal substitute.

    Treatment

    The patient underwent tangential excision and debridement two days after formal fluid resuscitation was completed (Fig. 2). Following excision and debridement, a meshed bovine dermal matrix was initially placed onto the exposed muscle of the posterior torso. After 5 days, the meshed bovine dermal matrix was found not to be a suitable option for this patient’s wounds due to poor engraftment and desiccation of the dermal matrix (Fig. 3). The bovine dermal matrix was removed after failing to incorporate with the wound bed, and NovoSorb BTM was applied.

    NovoSorb BTM was secured using staples, and a bulky dressing consisting of silver antimicrobial properties, saline-soaked 10-ply, and burn pads with dry netting were applied to the torso. Four days post-application, hematomas were noted and the fluid collections and overlying piece of NovoSorb BTM were removed (Fig. 4). Active bleeding was cauterized with an electrocautery device or managed with absorbable sutures. A new piece of NovoSorb BTM was applied to the resolved area and NovoSorb BTM showed early signs of adherence to most of the torso, with exception of the left exposed scapula.

    At 20 days post NovoSorb BTM application, the sealing membrane was removed from the posterior torso, and the wound bed was prepared using hydrosurgical excision. The wound was closed with a combination of a 3:1 split-thickness skin graft (STSG) sprayed with autologous skin cell suspension. The STSG was successful with exception of the left scapula which healed by contracture.

    Outcome

    The patient’s wounds were completely re-epithelialized at 7 months after the initial incident and were beginning to mature (Fig. 5). Upon physical examination, the skin was smooth and pliable. Of note, the patient had decreased range of motion due to scar bands on his bilateral posterior shoulders. These can be managed with future therapy and an adjacent tissue rearrangement if the patient desires. At follow-up, the patient was happy with his outcomes. He can perform his daily living activities without assistance and is regaining some of the weight lost during his hospitalization.

    A 44-year-old African American male sustained a traumatic abrasion to his posterior torso (Fig. 1) and other locations after being hit and dragged underneath a moving vehicle for an unknown distance.

    The patient had multiple comorbidities including HIV, alcohol-induced chronic pancreatitis, polysubstance abuse, and poorly controlled diabetes which limited reconstructive options and increased wound care risks. NovoSorb BTM was selected as the most suitable option for treatment after failure of a biological dermal matrix.

    Reconstructive options included the excision and debridement of necrotic tissue followed by conservative wound care with risks of infection, sepsis, death, and/or hospice. Local flap coverage for exposed bone was discussed with the plastic surgery team but ultimately rejected due to the patient’s comorbidities and injuries that extended into muscle. After a thorough discussion with the clinical team and the patient’s family, it was decided to remove all necrotic tissue and attempt wound closure initially with the help of a biological dermal substitute.

    The patient underwent tangential excision and debridement two days after formal fluid resuscitation was completed (Fig. 2). Following excision and debridement, a meshed bovine dermal matrix was initially placed onto the exposed muscle of the posterior torso. After 5 days, the meshed bovine dermal matrix was found not to be a suitable option for this patient’s wounds due to poor engraftment and desiccation of the dermal matrix (Fig. 3). The bovine dermal matrix was removed after failing to incorporate with the wound bed, and NovoSorb BTM was applied.

    NovoSorb BTM was secured using staples, and a bulky dressing consisting of silver antimicrobial properties, saline-soaked 10-ply, and burn pads with dry netting were applied to the torso. Four days post-application, hematomas were noted and the fluid collections and overlying piece of NovoSorb BTM were removed (Fig. 4). Active bleeding was cauterized with an electrocautery device or managed with absorbable sutures. A new piece of NovoSorb BTM was applied to the resolved area and NovoSorb BTM showed early signs of adherence to most of the torso, with exception of the left exposed scapula.

    At 20 days post NovoSorb BTM application, the sealing membrane was removed from the posterior torso, and the wound bed was prepared using hydrosurgical excision. The wound was closed with a combination of a 3:1 split-thickness skin graft (STSG) sprayed with autologous skin cell suspension. The STSG was successful with exception of the left scapula which healed by contracture.

    The patient’s wounds were completely re-epithelialized at 7 months after the initial incident and were beginning to mature (Fig. 5). Upon physical examination, the skin was smooth and pliable. Of note, the patient had decreased range of motion due to scar bands on his bilateral posterior shoulders. These can be managed with future therapy and an adjacent tissue rearrangement if the patient desires. At follow-up, the patient was happy with his outcomes. He can perform his daily living activities without assistance and is regaining some of the weight lost during his hospitalization.