Two-stage Reconstruction of Acute Extensive Third-degree Burn Using Biodegradable Temporizing Matrix (NovoSorb BTM)

Summary: Patients with large total body surface area (TBSA) burns face significantly elevated risks of morbidity and mortality. Achieving rapid, durable wound closure with minimal risk of infection or systemic compromise is critical to reducing mortality. Biodegradable Temporizing Matrix (BTM) (PolyNovo, Victoria, Australia) offers a synthetic alternative to biological dermal substitutes, providing temporal wound closure and a scaffold for neodermis generation. A 68-year-old woman presented with third-degree flame burns covering 25% TBSA across the right trunk and upper limb following a domestic syncopal episode. After initial stabilization, the patient underwent a 2-stage reconstruction. Stage I (postburn day 4) involved surgical excision to the fascia and immediate application of BTM. Stage II (postburn day 39) involved the delamination of the sealing layer and coverage of the vascularized neodermis using split-thickness skin grafts, meshed at a ratio of 1:1.5. BTM was successfully integrated within 35 days, exhibiting the characteristic uniform pink color of vascular network formation. Complete epithelialization was documented by postburn day 75, with no clinical signs of infection observed throughout the treatment course. Follow-up at postburn day 377 demonstrated satisfactory functional recovery and favorable long-term scar quality, with minimal secondary contracture. BTM provided temporal closure that was less prone to infection, which proved invaluable in managing this extensive burn in a high-risk patient. Successful neodermis regeneration improves the split-thickness skin graft coverage characteristics and supports the use of BTM as an effective reconstructive modality for deep, large-TBSA burns, where minimizing risk of infection and fluid loss is paramount, while simultaneously allowing for improved functional and aesthetic outcomes.