Biodegradable Temporising Matrix: The Rising Star in Synthetic Skin Substitutes for the Hand?

Introduction: Treatment of skin defects in the hand after severe trauma, infections or burns can be challenging. The use of Biodegradable Temporising Matrix may serve as a new soft tissue cover, if skin grafts alone do not heal and flaps are not an option. With the BTM technique a soft tissue defect is closed with a non-biodegradable layer that providing a better barrier against bacteria. Method: Between December 2021 and December 2022, 27 patients were treated with BTM. In 20 cases the soft tissue defect was caused by a severe trauma. In four patients, there was a skin defect after an infection and in one case each, it was caused by an epitheloid sarcoma, by Dupuytren's disease and MDA5 Dermatomyositis. Following debridement, BTM was applied to the wound. After the granulation tissue has fully integrated into the BTM layer, the sealing membrane is removed and a split-thickness skin graft was applied to the vascularized layer. Results: The BTM was applied in 9 cases on exposed extensor tendons, in 9 cases on muscle or soft tissue, in 5 cases on bone, in 2 cases on the neurovascular bundle and in 1 case each on exposed flexor tendon and nerve transfer. One infection with enterobacter cloacae was observed after BTM application. The split-thickness graft was well integrated after five days. Conclusion: The use of BTM is an alternative option with good healing potential, especially in multimorbid patients, who do not qualify for a vascularized flap and who have reduced mobility requirements.