The use of NovoSorb biodegradable temporising matrix in wound management: a literature review and case series.

OBJECTIVE: NovoSorb (Poly-Novo Ltd, Australia) biodegradable temporising matrix (BTM) is a novel artificial dermal matrix. Previous literature is weighted towards its use in burns reconstruction; however, this paper describes its use within a range of wound aetiologies. The authors present one of the largest and most diverse case series to date, and aim to provide an independent benchmark of clinical practice. METHOD: A retrospective observational study was performed. Patient demographics and clinical data (wound aetiology, site, total body surface area (TBSA), wound bed, number of debridements, time to BTM integration, time to skin grafting) were collected and subgroup analysis preformed. RESULTS: The cohort consisted of 37 patients (acute trauma wounds, n=19; hard-to-heal wounds, n=9; acute infections, n=6; cancer, n=3). Successful BTM integration, allowing subsequent split-thickness skin grafting (STSG), occurred in 70% of cases, despite an overall complication rate of 51%. Mean time from BTM application to STSG was 53 days. There was no difference in STSG outcomes when grafting was performed either before or after the six-week BTM application period. There was no difference when various wound beds (fascia, tendon, periosteum) were compared. Patients >65 years of age were more likely to experience complications; however, this did not affect the speed of integration. The relation of diabetes and smoking to overall integration had no statistical significance. CONCLUSION: In comorbid patients in particular, the time between BTM application and STSG may be longer than the manufacturer's recommendation. Furthermore, data suggest greater wound bed optimisation and closer interval monitoring in hard-to-heal/malignant wounds, and in older patients and patients with comorbidities. However, BTM appears robust (even in infection) and is showing promise as a useful reconstructive tool.

Patient-reported outcomes for nipple reconstruction: Review of literature.

BACKGROUND: There is currently no validated patient-reported outcome measure (PROM) that is specific to nipple-areola complex (NAC) reconstruction. This paper evaluates all patient-reported outcomes for NAC reconstruction in the literature. METHODS: Systematic literature searches of The Cochrane Central Register of Controlled Trials, MEDLINE and World Health Organization International Clinical Trials Registry Platform were conducted to identify all primary studies with patient-reported outcomes for NAC reconstruction. The primary outcome measures were patient satisfaction rates for appearance and symmetry of NAC reconstruction. RESULTS: Fifty-nine papers were included in this review. Reported patient satisfaction was generally high, with the pooled average satisfaction rate for appearance being 81.9% and symmetry 80.3%. 89.5% of respondents would do it again and 94.8% would recommend it to others. There is no standardised or validated PROM specific to NAC reconstruction and this contributes to a lack of conclusive findings from studies in this area. CONCLUSION: There is a need for a validated PROM that is specific to NAC reconstruction, in order to serve as a standardised outcome assessment to guide further research and improve patient care.

Role of negative pressure wound therapy in healing of diabetic foot ulcers.

INTRODUCTION: Foot disorders such as ulceration, infection and gangrene are the most common, complex and costly sequelae of diabetes mellitus.[1-3] Even for the most superficial wounds, treatment is often difficult with poor healing responses and high rates of complications. The purpose of this study is to compare the rate of ulcer healing with the negative pressure dressing technique to conventional moist dressings in the treatment of diabetic foot ulcers. MATERIALS AND METHODS: The study was conducted on 30 patients, which were divided into two groups. One group received negative pressure dressing while other group received conventional saline moistened gauze dressing. Results were compared for rate of wound healing. RESULTS: There was a statistically significant difference in the rate of appearance of granulation tissue between the two groups; with granulation tissue appearing earlier in the study group. The study group promised a better outcome (80% complete responders) as compared to the control group (60% complete responders). CONCLUSIONS: Negative pressure wound therapy has a definitive role in healing of diabetic foot ulcers.

A retrospective analysis of 189 patients of maxillofacial injuries presenting to a tertiary care hospital in Punjab, India.

INTRODUCTION: Maxillofacial injuries form a major aspect of trauma management in trauma centers. Prompt diagnosis and management is needed to provide better quality of life and cosmetic results as compared to delayed interventions. MATERIAL AND METHODS: We present a retrospective study of 189 patients of complex, operable maxillofacial injury with an analysis of patients'; age and gender, mode of injury, vehicle details and associated injuries along with the maxillofacial injuries admitted in a tertiary care hospital in Northern India over one year. RESULTS: Maximum patients were in the age group of 21-30, a decade early as compared to other figures, with fractures of zygoma being predominant associated with head injury as the commonest comorbid condition. Motorized two wheelers were the leading cause with more than 75% patients driving at the time of injury. Majority of the injuries were not singular and in concordance with the literature men were the most affected. DISCUSSION: Motor vehicle accident is the most common cause for maxillofacial injury worldwide. Being a referral hospital the number of patients were low but the complexity was high with a reverse trend towards the type of injuries seen and the ones found in community hospitals. The stand alone factor of this study with respect to the other publications is the presentation of the associated symptom complex with the specified fracture and the type, number and rotation of fracture segments with each facial bone fracture; the location of the patient at the time of impact in the vehicle, type of vehicle and the associated injuries.