Presented is the case of an obese, 72 year-old diabetic man with a dorsal foot de-gloving injury. Whilst the tendons of extensor hallucis longus, extensor digitorum longus to all digits, and extensor digitorum brevis to hallux and second toe were intact after surgical debridement, none had any covering paratenon. The joint between the medial cuneiform and first metatarsal was open. Reconstructive options were limited by his age and co-morbidities. A novel, completely synthetic dermal matrix (NovoSorb BTM) was applied, after which the patient was discharged home to attend for dressings and review of integration progress as an outpatient. He was allowed to mobilise without limitation. Because of the poor quality of the wound bed (and patient), the material integrated slowly over 9 weeks. Delamination of the matrix, and definitive closure by application of sheet split skin autograft, produced a robust, soft, mobile and excellent aesthetic result, over which he could wear footwear immediately. Clinically, the paratenon-denuded tendons glided under the neo-dermis without tethering to the overlying integrated matrix, allowing a full range of digital movement. This was confirmed on ultrasound examination, which also demonstrated no inflammation or oedema. Already proven in extensive burns, necrotising fasciitis and complex surgical wounds, BTM represents a useful addition to the reconstructive surgeon’s toolbox.
From the *Adult Burn Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
†Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, South Australia.
Published online 2 April 2019.
Received for publication October 20, 2018; accepted November 26, 2018.
Disclosure: Dr. Greenwood and Dr. Wagstaff are shareholders of PolyNovo Biomaterials Pty Ltd, Port Melbourne, Victoria, Australia, the company that manufacture NovoSorb BTM. Ms. Damkat-Thomas has no financial disclosures.
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John E. Greenwood, AM, BSc(Hons), MBChB, MD, DHlthSc, FRCS(Eng), FRCS(Plast), FRACS, Adult Burn Service, Level 7, G Wing, Royal Adelaide Hospital, 1 Port Road, Adelaide 5000, South Australia, E-mail: email@example.com
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