Application of a synthetic biodegradable dermal matrix to a difficult-to-heal ulcer

Abstract

Introduction: Neuroischemic ulcers in the diabetic foot represent a complex reconstructive challenge. Biodegradable synthetic bilayer dermal matrices (NovoSorb® BTM) offer an advanced alternative to induce dermal regeneration.

Objective: To document the clinical experience and evaluate the effectiveness of the NovoSorb® BTM biodegradable temporizing matrix in the treatment of a long-standing perforating plantar ulcer.

Case Description: A 63-year-old male with type II diabetes, peripheral arterial disease, neuropathy, and a history of multiple previous amputations. He presented with a neuroischemic plantar ulcer refractory to healing.

Care Plan: Structured according to the NANDA/NOC/NIC taxonomy, prioritizing Impaired skin integrity, Acute pain, and Risk for infection. Interventions focused on wound bed preparation, matrix fixation using negative pressure wound therapy, and exudate management.

Evolution: At two weeks, matrix lifting was detected due to a localized infection by oxacillin-resistant Staphylococcus aureus (MRSA).

Interventions: Given the local complication, a rescue protocol of the neodermis was executed through mechanical drainage via micro-incisions, targeted oral antibiotic therapy, and localized wound care

Results: Infection eradication and preservation of matrix viability were successfully achieved. Programmed delamination was performed at 4 weeks, leading to complete epithelialization and wound closure by secondary intention, thereby avoiding further surgical interventions.

Conclusions: The use of BTM stands out as an innovative and effective approach for complex wounds. Close monitoring and nursing management of local complications proved to be decisive factors in ensuring matrix integration and definitive wound closure.