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Split Skin Graft Application Over an Integrating, Biodegradable Temporizing Polymer Matrix: Immediate and Delayed

Greenwood, John Edward AM, MBChB, MD, FRACS; Dearman, Bronwyn Louise BSc(Hons)

doi: 10.1097/BCR.0b013e3182372be9
2011 Burke/Yannas Bioengineering Award

The objective of this study is to further investigate the NovoSorb™ biodegradable polyurethane in generating dermal scaffolds; to perform a pilot study comparing the previously used spun mat against a recently developed NovoSorb™ foam, ascertaining the optimum structure of the matrix; and to evaluate the successful matrix as an immediate adjunct to split skin grafting and as a temporizing matrix in a prospective six-pig study. A pilot study comparing a previously investigated form of the polymer (spun mat) against a new structural form, a foam, was performed. This was followed by a six-pig study of the foam matrix with three treatment arms—autologous split skin graft alone, polymer foam with immediate engraftment, and polymer foam with delayed engraftment. The foams allowed less wound contraction than the spun mats. The foam structure is less dense (cheaper to produce and having less degradation products). The material remained in situ despite clinical wound infection. Proof of concept was achieved in both treatment modalities in the main study. Split skin graft applied immediately over the polymer foam was able to engraft successfully. The result was “thicker” to pinch and “flush” with the skin surrounding the wound. There was no significant difference in the degree of wound contraction between the graft alone and the polymer plus immediate graft groups. Split skin graft also “took” when applied to the surface of a polymer that had been applied to a wound 11 days earlier, again with a thicker result, flush with the surrounding skin. Split skin grafts alone left a persisting depression. However, a significant degree of wound contraction (compared with the other two groups) was observed in the polymer plus delayed graft group. This has prompted further investigation into “sealing” the polymer foam with a membrane, to prevent evaporative water loss, when the foam is to be used as a biodegradable temporizing matrix. The studies indicate that the NovoSorb™ platform will allow the creation of two inexpensive dermal matrix products; an immediate scaffold to allow a thicker grafting result and a biodegradable temporizing matrix (BTM) for wound integration after burn debridement while donor sites become reharvestable. However, further modification on the BTM structure is necessary to further reduce wound contraction pregrafting.

From the *Adult Burn Centre and †Skin Engineering Laboratory, Royal Adelaide Hospital, Adelaide, South Australia.

Presented at the 43rd annual meeting of the American Burn Association, Chicago, Illinois, March 29 to April 1, 2011.

PolyNovo Biomaterials Pty Ltd, a privately owned company based in Port Melbourne, Victoria, Australia, produces NovoSorb™. NovoSkin Pty Ltd is a joint venture company established to investigate the potential of NovoSorb™ in the field of deep burn injury. A/Professor Greenwood has a 20% shareholding in NovoSkin Pty Ltd.

Address correspondence to John Edward Greenwood, AM, MBChB, MD, FRACS, Director, Adult Burn Centre, Royal Adelaide Hospital, North Terrace, Adelaide 5000, South Australia, Australia. Email:

© 2012 The American Burn Association