NovoSorb Biodegradable Temporizing Matrix for Reconstruction of Multiplanar Degloving Injury of the Upper Limb

Abstract

Originally described as "wringer injuries" by MacCollum in 1938,¹ traumatic multiplanar degloving injuries that occur as the result of the hand, forearm or arm being drawn between the rollers of a machine are functionally devastating and present a significant reconstructive challenge. Revascularization and comprehensive excision of devitalized bone and soft tissue, followed by appropriate skeletal fixation and vascularized soft tissue cover are the mainstays of management. To date, published case series have described local flaps and free tissue transfer for coverage of wounds that involve exposed vital structures such as nerves, vessels, and tendons.² NovoSorb biodegradable temporizing matrix (BTM; PolyNovo Biomaterials Pty Ltd, Melbourne, Australia) is a bilayer bioabsorbable synthetic polymer dermal substitute, which has the ability to integrate into large wound beds and is resistant to infection.³ BTM comprises a bioabsorbable, polyurethane matrix that allows for cellular infiltration and a temporary nonbiodegradable, nonporous polyurethane layer, which limits moisture loss and provides a barrier to bacteria. Here we describe the successful use of BTM in the staged reconstruction of a high-energy industrial roller injury in an adolescent patient.

Fig. 1.

Wound at day 0, ready for application of BTM. Exposed critical structures as follow: saphenous vein graft to brachial artery (a), median nerve (b), and medial epicondyle (c).

Fig. 2.

Wound at day 42, BTM fully integrated.

Fig. 3.

Wound at day 47, first graft check.

Fig. 4.

Patient at 12 month follow-up.