Comparing Biodegradable Temporizing Matrix and 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: Skin-substitutes are an integral tool in soft-tissue reconstruction. This study aims to compare Novosorb Biodegradable Temporizing Matrix (BTM) and Integra collagen-chondroitin silicone (CCS) skin-substitutes for wound reconstruction. Methods: This single-center retrospective study included adult patients who underwent wound reconstruction with BTM or CCS between January 2015 and July 2020. Patient-level data and outcomes including complications and closure were recorded. Result:s Ninety-seven patients were included: 51 (52.6%) BTM and 46 (47.4%) CCS. Mean age at dermal template placement was 48.2+/-17.1 years. Race, sex, smoking, comorbidities, defect size, and follow-up were similar between groups. Wound etiologies for BTM and CCS included burn (13.7% vs 45.7%), trauma (47.1% vs 28.3%), surgical wounds (19.6% vs 10.9%), osteomyelitis (3.9% vs 2.2%), compartment syndrome (3.9% vs 2.2%), and skin cancer (3.9% vs 2.2%), respectively (p=0.006). Wound location for BTM and CCS were upper extremity (37.1% vs 32.6%), lower extremity (41.2% vs 28.3%), trunk (2.0% vs 17.4%), and face/neck (9.8% vs 21.7%), respectively (p=0.012). Median template size was 147 cm2 for BTM and 100 cm2 for CCS (p=0.337). Skin-grafts were more frequently applied after CCS placement, in 39 (84.8%) CCS wounds compared to 28 (54.9%) BTM (p=0.006), with the remainder of wounds healing secondarily or lost to follow-up. Template reapplication was similar between groups at 19.6% each (p=1.0). Template and skin-graft complications of infection, dehiscence, and hematoma/seroma were comparable between groups. Skin-graft failure was significantly higher in the CCS group at 9 (23.1%) compared to 1 (3.6%) BTM (p=0.006). More secondary procedures were required after CCS placement (CCS, 1.9+/-1.8; BTM, 1.0+/-0.9; p=0.002). Final closure was achieved in 31 (60.8%) BTM and 28 (60.9%) CCS cases (p=0.655), with similar mean time to closure (BTM, 5.4+/-3.8; CCS, 6.4+/-8.9 months, p=0.591). On univariable analysis, older age, larger template size, lower body mass index, current smoking, lower extremity wounds, and surgical wounds were associated with lower rates of closure, although only template size was significant (p=0.034). On multivariable analysis, only iatrogenic wound etiology was a significant predictor of failure to achieve closure (p=0.047). Conclusion: Compared to CCS, the new-generation skin-substitute BTM had comparable closure and complication rates for infection, dehiscence, hematoma, and seroma. Despite larger template sizes, wounds treated with BTM required fewer secondary procedures, fewer skin-grafts, and subsequent skin-grafts were less likely to fail. At our institution, BTM costs $850 per 100 cm2 compared to $8130 for CCS, suggesting BTM is a superior economical option for wound repair.
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