Biodegradable Temporising matrix in the reconstruction of complex wounds: A systematic review and meta-analysis

Abstract

Objective: To assess the efficacy of biodegradable temporising matrix (BTM) in complex wound reconstruction.

Methods: The authors conducted a systematic review and meta-analysis as per the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines following a literature search assessing BTM in complex wound reconstruction. The primary outcome measures included the proportion of BTM integration as well as integration time. Secondary outcomes included graft take over BTM, infection rate and other complications as well as scar outcome.

Results: Twenty six studies met the inclusion criteria with a total of 1153 complex wounds. The mean proportional integration was 92.7% at (95% confidence intervals [CI] 88.57, 96.87, p < 0.001) with a mean integration time of 34.05 days (95% CI 33.33, 34.79, p < 0.001). The infection rate was low at 12.6% with an untransformed proportion metric assessment (0.126, 0.08-0.168, p < 0.001) at the site of BTM application. Favourable scar outcomes were reported using the matching assessment using photographs with scars (MAPS) and patient and observer scar assessment scales (POSAS).

Conclusion: BTM offers a robust dermal template in reconstruction of complex wounds. The authors recommend for randomised controlled trials to enhance the current evidence base.

Keywords: biodegradable temporising matrix; complex wound; dermal substitute.

FIGURE 1

Preferred reporting items for systematic review and meta‐analysis (PRISMA) flow chart illustrating article screening and selection.

FIGURE 2

Percentage proportion of biodegradable temporising matrix (BTM) integration overall with a mean analysis; 92.7 (88.57, 96.87) standard error 2.117, p < 0.001.

FIGURE 3

Biodegradable temporising matrix (BTM) integration (days) as analysed in 16 studies at 95% confidence intervals, mean time: 34.05 days (33.326, 34.785), standard error 0.372, p < 0.001.

FIGURE 4

Mean difference analysis comparing biodegradable temporising matrix (BTM) integration time (days) on bone versus other wound bed types (neurovascular structures, fascia, fat, muscle, perichondrium, granulation, submandibular gland, testicle and cartilage). Mean difference: 5.790 (1.649, 9.930) p = 0.006.

FIGURE 5

Mean analysis for biodegradable temporising matrix (BTM) integration time on bone (days): 40.665 (35.821, 45.508), standard error 2.47, p < 0.001.

FIGURE 6

Mean difference analysis comparing biodegradable temporising matrix (BTM) integration time (days) on bone to tendon. No significant difference seen: 4.037 (−4.471, 12.546), p = 0.352.

FIGURE 7

Mean difference assessment of biodegradable temporising matrix (BTM) integration time on tendon versus other soft tissues (neurovascular structures, fascia, fat, muscle, perichondrium, granulation, submandibular gland, testicle and cartilage). Mean difference 3.481 (−0.860, 7.821), p = 0.116.

FIGURE 8

Mean assessment of average integration time for biodegradable temporising matrix (BTM) over tendons(days); 37.432 (28.477, 46.388), Standard error 4.569, p < 0.001.

FIGURE 9

Split thickness skin graft (SSG) take over biodegradable temporising matrix (BTM) template as analysed in nine studies, mean percentage: 98.925% (95% confidence intervals: 98.359, 99.491), standard error 0.289, p = 0.001.

FIGURE 10

Infection rate for biodegradable temporising matrix (BTM) in complex wound reconstruction, 12.6% with an untransformed proportion metric (0.126, 0.084, 0.168), Heterogeneity, I ² = 63.33%, p < 0.001. Standard error 0.021, p = 0.001.

FIGURE 11

Sensitivity analysis of infection rate comparing high risk wounds (necrotising fasciitis post debridement, diabetic wounds, pressure ulcers, previous infection and any chronic or ischaemic wounds) versus those in the general population. No significant difference seen; odds ratio estimate 0.951 (0.302, 2.989), p = 0.931.

FIGURE 12

Odds ratio analysis of infection rate compared to other device related complications in biodegradable temporising matrix (BTM) application. The infection rate was significantly lower on assessment: 0.421 (0.281, 0.629, p = 0.281).