Introduction/ Objective:
Novosorb ® BTM (Biodegradable Temporizing Matrix) is a synthetic polyurethane bilayer matrix developed in Australia, indicated in wounds with full thickness soft tissue loss, was approved by TFDA (Taiwan Food and Drug Administration) in 2020. As experience sharing, we present a case with necrotizing fasciitis of lower limb that was reconstructed with BTM with Negative Pressure Wound Therapy (NPWT) after serial debridement.
Case/ Material and Methods:
The 49 year-old male was diagnosed of necrotizing fasciitis over left gluteal, perineal and whole lower leg (TBSA 12.5%) with septic shock. He underwent fasciotomy and diversion colostomy at other hospital and referred to us for further treatment. Serial radical debridements were performed. Due to large areas of skin defect, we make plans of reconstruction with BTM for areas with tendon exposure; for those areas with good granulation tissue growth without tendon or fascia exposure, split-thickness skin grafting was done directly. All the wounds were covered with NPWT. The wound was checked weekly, on the 16th day after BTM application, salmon pink color on the surface of BTM was seen and the sealing membrane was delaminated. Further STSGs were grafted to these areas.
Results:
The wound received the two-step reconstruction, showing good taken of BTM. The synthetic matrix was successfully filled with neodermis and well angiogenesis. The course of BTM implantation combined with NPWT was 16 days in this case, which was shorter than the average time of 24 days without using NPWT in other case reports. The STSG grafted on the delaminated BTM was nearly fully adherent. The result showed a well-contoured reconstruction with preserved passive range of motion (ROM).
Conclusion:
As our reconstruction plan, dermal substitutes with skin grafts was considered prior to flap. The two-step reconstruction with BTM and STSG, combined with NPWT accelerated the wound healing without infection, shortened the immobility time, and let the patient start rehabilitation earlier.

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