Background:
Biodegradable Temporising Matrix (BTM) is an implantable bilayered synthetic matrix. It produces a more robust neo-dermal layer to the wound than a split thickness skin graft(STSG) alone by adding volume, improving blood-supply, and increasing durability.
Case:
Our patient is a 76 year-old male who presented with circumferential SCC arising within a chronic ulcer and encompassing 50% of the vertical length of the right lower leg. This was on a background of sustaining bilateral full-thickness lower limb burns at 12 years-old which was at that time managed with extensive STSGs. He had undergone a previous left leg above-knee amputation, meaning the patient now depended on his right leg to maintain mobility and independence with an even greater emphasis on performing limb-salvaging surgery. Biopsies and subsequent imaging studies of the right leg lesions revealed a circumferential, well differentiated SCC that extended down to muscle fascia without muscular or bony involvement. The only flap-based reconstructive option for the resulting defect would’ve been a latissimus dorsi (LD) flap. With his dependence on upper limb strength for his mobility, a free LD flap would have significantly impacted upon this. A decision was, therefore, made to proceed with a staged BTM and subsequent STSG reconstruction.
Outcome:
A clear resection margin was achieved with the deep margin taken down to muscle belly and tendon. Through use of BTM, we were able to provide a more robust reconstruction than a STSG alone. There was 95% graft take at 1 week post-STSG, and return to baseline mobility with a fully healed robust and pliable wound by 5 weeks, and no wound complication at 5 months. Although radiotherapy wasn’t eventually required, the wound was robust enough at week 4 post-STSG to have begun radiotherapy. BTM is a valuable adjunct in reconstructing extensive oncological defects.