A case series to evaluate burn therapy practices after application of Biodegradable Temporising Matrix (BTM)

Abstract

Objective

Evolution in the use of Biodegradable Temporising Matrix (BTM) in our adult burn service prompted an evaluation of our therapy guidelines.

Method

We conducted a retrospective case note review of adult burn patients who received BTM between March 2022 and September 2024. Data collected included commencement timing of range of motion (ROM) and ambulation after BTM application, burn and BTM total body surface area (%TBSA) and reason for any BTM loss.

Results

The study included 22 patients (23 procedures). Overall, median burn TBSA was 30% with median BTM TBSA of 22% (BTM range 0.1%–70% TBSA). All patients had BTM crossing at least one upper limb (UL) or lower limb (LL) joint. Median time to ROM initiation after BTM was 4.5 days for UL and 2.0 days for LL. Median time to ambulation was 1.0 day overall. Among LL BTM patients intubated for < 7 days, ambulation commenced at a median of 1.5 days. Larger LL BTM areas (>10% TBSA) were slower to mobilise than smaller (<10% TBSA) areas (median 2.5 vs 1.0 days). Partial BTM loss occurred in six cases (26%), though none were attributed to therapy interventions.

Conclusion

Therapy guidelines in our burns unit now recommend initiating gentle ROM within 3–5 days after BTM application, and ambulation from day 2–3, even in patients with large LL BTM areas, without negatively impacting BTM integration or timing to SSG.

Plain language summary

Study to evaluate when joint movement and ambulation (sitting on edge of bed and walking) can safely start after the application of Biodegradable Temporising Matrix (BTM) in burn injured patients.

Plain language title

Why the study was done?

Early movement and walking are important for burn injury recovery to prevent complications but there is not enough guidance for when this can safely commence for patients treated with a synthetic skin substitute called Biodegradable Temporising Matrix (BTM). This study aimed to review recent patient cases to assess current practices with regard to movement and ambulation after BTM application and suggest new guidelines to improve care.

What was done

Information was collected from the medical notes of all burn patients treated with BTM in the researchers’ burns unit between March 2022 and September 2024.

Key findings

Patients with BTM on their arms started joint movement after about 4-5 days. Patients with BTM on their legs started joint movement after about 2 days. Most people with BTM covering their legs/hips or buttocks started attempting to stand and walk after about 2 days (unless they were on a ventilator). Patients with smaller areas of lower limb BTM began attempting to stand and walk sooner (1-2 days) than those with larger areas of lower limb BTM (2-3 days).

BTM loss or removal occurred in six patients (27%) but upon doctor review this BTM loss was not caused by joint movement, exercises or walking but rather due to infection or other wound problems.

Conclusion

After BTM, patients can safely begin limb movements within 3–5 days and walking within 2-3 days, without affecting healing or timing for skin graft surgery.