Head and Neck Wound Reconstruction with Biodegradable Temporizing Matrix versus Collagen-Chondroitin Silicone Bilayer Dermal Regeneration Substitutes
Shannon S. Wu, BA1, Michael Wells, MEng2, Mona Ascha, MD3, James Gatherwright, MD4, Kyle J. Chepla, MD4
1Cleveland Clinic Lerner College of Medicine, Cleveland, OH, 2Case Western Reserve University, School of Medicine, 3Department of Plastic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, 4Plastic Surgery, MetroHealth Medical Center, Cleveland, OH
Purpose: Head and neck reconstruction is challenging owing to the high functional requirements of movement, sensation, and aesthetic goals of this region. This study is the first to compare Novosorb Biodegradable Temporizing Matrix (BTM) and Integra collagen-chondroitin silicone (CCS) skin-substitutes for reconstructing soft-tissue wounds of the head/neck in patients. Methods: We retrospectively reviewed adult patients who underwent wound reconstruction of the head/neck with BTM or CCS between January 2015 and August 2020. Patient-level data, complications, and closure rates were recorded. Categorical variables were compared with Fisher's exact test and continuous variables with Mann-Whitney U test. Result:s Fifteen patients with head/neck wounds were identified, 5 (33%) were treated with BTM and 10 (67%) with CCS. Mean age at dermal template placement was 55 years (range, 28-79). Race, gender, smoking status, comorbidities, defect size, radiation history, prior surgeries, and follow-up were similar between groups. Wound etiologies for BTM and CCS included burn (40% vs 60%), trauma (20% vs 20%), surgical wounds (20% vs 20%), and skin cancer (20% vs 0%), respectively (p=0.026). Median template size was 225 cm2 for BTM and 238 cm2 or CCS (p=0.951). Skin grafts were placed in 8 (80%) wounds after CCS placement, compared to 3 (60%) after BTM (p=0.670), with the remainder of wounds healing secondarily or lost to follow-up. Template reapplication was required in 2 (40%) of BTM wounds and 3 (30%) of CCS wounds (p=1.0). Template and skin-graft complications of infection and hematoma/seroma were comparable between groups, and skin-graft failure was higher in the CCS group at 3 (37.5%) compared to 0 BTM (p=0.506). More secondary procedures were required after CCS placement (CCS, 1.9+/-2.2; BTM, 0.9+/-0.8; p=0.090). Final closure was achieved in 2 (40%) BTM and 6 (60%) CCS cases (p=0.608). On univariable analysis, older age, larger template size, lower body mass index, current smoker, and burns were associated with longer time to closure, although no individual variable was significantly associated. Conclusion: Wounds of the head/neck treated with the new-generation skin-substitute BTM had comparable closure and complication rates compared to the gold-standard CCS bilayer. Wounds treated with BTM required fewer secondary procedures, fewer skin-grafts, and subsequent skin-grafts were less likely to fail. Future randomized trials with larger cohorts are needed to compare these materials. BTM may be an economic alternative to CCS, as the cost of BTM is $850 per 100 cm2 compared to $3150 for CCS bilayer at our institution.
Back to 2021 Abstracts