NovoSorb® BTM
Degloved foot with exposed tendons devoid of paratenon, underwent reconstruction with NovoSorb® BTM to maintain mobility and function.
Dr Lindsay Damkat-Thomas, Prof John Greenwood, and Assoc. Prof. Marcus Wagstaff
Royal Adelaide Hospital, SA, Australia
The patient presented with a traumatic degloving injury to the dorsum of his right foot. Reconstructive options were limited due to the significantly exposed tendons and the patient’s age and comorbidities. NovoSorb BTM was offered as a solution with definitive closure using a fenestrated split-thickness skin graft. The reconstruction produced a robust, soft, mobile, and excellent esthetic result with no underlying tethering of the tendons.
Figure 1: Initial presentation of soft-tissue loss.
Figure 2: Debrided wound with extensive exposed tendons.
Figure 3: NovoSorb BTM applied with staples.
Figure 4: 9 weeks post NovoSorb BTM application; sealing membrane removed.
Figure 5: 1 day after skin grafting.
Figure 6: 9 months post NovoSorb BTM application; excellent esthetic result with soft and mobile reconstruction.
- Background
- Treatment
- Outcome
A 72-year-old Caucasian male degloved the dorsum soft tissue of his right foot when it caught between the car door and a metal cupboard in his garage (Fig. 1). The patient’s comorbidities included obesity, diabetes, and hypertension.
The avulsed soft tissues were extensively damaged, with the skin not being suitable for replantation. Due to the extent of tendon exposure, the wound bed was not viable for skin graft reconstruction without excision of the extensor tendons. Free flap surgery was considered but ultimately rejected by the patient who was keen to avoid prolonged surgery, associated donor site morbidity, and a bulky reconstruction of the foot contour making conventional shoes challenging to wear. NovoSorb BTM was therefore offered as a potential reconstructive solution.
Initial surgery involved extensive soft tissue debridement of the foot’s dorsum, exposing deep structures including bone (Fig. 2). Following debridement, negative pressure wound therapy (NPWT) was applied to the wound.
Subsequent surgery involved refreshing the wound bed and applying NovoSorb BTM with quilting staples (Fig. 3). At day 7 post NovoSorb BTM application, the patient was discharged home and attended outpatient dressing changes twice a week to monitor integration.
At 9 weeks post NovoSorb BTM application, the patient returned to the operating theatre to delaminate NovoSorb BTM by removing the sealing membrane (Fig. 4) and for definitive closure with a fenestrated sheet split-thickness skin graft (Fig. 5). A breakdown adjacent to the extensors hallucis longus (EHL) tendon required a further skin graft to be applied.
NovoSorb BTM with a split-thickness skin graft allowed the patient to wear footwear immediately upon successful wound closure.
At 9 months post NovoSorb BTM application, a robust, stable wound closure with excellent skin conformity was demonstrated (Fig. 6).
Range of motion of the toe extensors and ankle was restored. At 16 months, the patient had a mature, pliable scar. An ultrasound scan showed no evidence of tethering of the extensor tendons underneath the matrix with unimpeded movement of the EHL tendon.
Supplemental video 1:
Digital and ankle movement at 9 months post BTM application.1
Supplemental video 2:
Ultrasound demonstrates unimpeded movement of the EHL tendon over the integrated BTM at ~16 months post BTM application.1
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Assoc. Prof. Marcus Wagstaff, Plastic Surgeon
Royal Adelaide Hospital, SA, Australia
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