Integra® versus Novosorb® biodegradable temporizing matrix for burn wounds: a comparative systematic review and meta analysis.

BACKGROUND AND

OBJECTIVES

Integra® is a bovine-derived artificial dermal matrix (ADM) widely used in the management of burns. More recently, Novosorb® Biodegradable Temporizing Matrix (BTM) has emerged as a fully synthetic ADM product. While experience with Integra® and BTM has been separately reviewed, burn wound healing outcomes and infectious complications have yet to be pooled and compared.

METHODS

Following librarian-reviewed systematic search, a mixed-effects meta-regression model was fitted based on all studies with ADM type as a categorical moderator. A two-stage individual patient data (IPD) meta-analysis was also conducted.

RESULTS

Thirty-five studies were included, the majority of which were non-comparative case series. Nineteen studies provided IPD. 674 patients were treated with Integra® and 288 with BTM. Integration time prior to second stage skin grafting was significantly longer with BTM than Integra® (32.11 vs 18.4 days, p < 0.01). Skin graft take was higher with BTM than Integra® when effects of NPWT use, template size and patient age were adjusted on meta-regression (90.6 vs 77.2 %, p = 0.016). This remained significant on two-stage IPD meta-analysis and exclusion of studies with high risk of bias. Moderator-adjusted infection rate was higher with BTM than Integra® (22.8 vs 2.96 %, p = 0.0072), but no differences were observed in average template take or infection-related reoperation rate. Wound closure rate, defined as > 95 % wound epithelialization, was comparable with BTM and Integra® (96.0 vs 96.5 %, p = 0.81).

DISCUSSION: While acknowledging BTM's prolonged healing timeline with no difference in overall wound closure rate, BTM may offer improved graft take and greater salvageability than Integra® in the event of infection.

SUMMARY AND

CONCLUSION

Very low-quality evidence suggests that BTM is associated with longer integration time and higher graft take when compared to Integra®. Infection rate was higher with BTM than Integra® but there was no difference in template take or need for reoperation. Overall wound closure rates were comparable.