Early Experience With Utilizing Biodegradable Temporizing Matrix (BTM) for Complex Pediatric Wound Reconstruction

Background: Biodegradable Temporizing Matrix (BTM) is a synthetic dermal regeneration template composed of a polyurethane bilayer matrix. Although the use of BTM is well established in adult burn populations, its application for complex pediatric wounds is only beginning to emerge. This case series describes our institution's early experience with BTM for managing a variety of complex pediatric wounds. Method: A retrospective chart review was conducted at the Alberta Children's Hospital examining children with complex wounds treated with BTM. Data collected included etiology of the wound, rationale for BTM selection, size of wound, time to wound closure or coverage with split-thickness skin graft (STSG), complications and cosmetic/functional outcomes. Results: Eleven children (age range: 2 weeks to 15 years) had wounds treated with BTM between December 2023 and December 2024. The etiology of the wounds varied (eg, trauma, infection, pressure, and postsurgical). Several patients had wound with complicating factors including sepsis, immunosuppression, or exposed critical structures (eg, dura and joint capsule). There was 1 treatment failure in a patient with cognitive delay who removed the BTM 1 week after application. Following BTM application, 6 patients subsequently underwent application of STSG while the other 5 patients healed spontaneously by secondary intention. Wound colonization was the most common complication (5 patients); these were all successfully managed with oral antibiotics. Conclusion: BTM is a useful reconstructive option for managing challenging wounds in children and can be utilized in variety of ways. Specific indications for BTM and its relative position on the reconstructive ladder are still evolving. We outline 5 key learning points that may be considered when using BTM in a pediatric population.