What is BTM?
BTM stands for Biodegradable Temporising Matrix. It is a synthetic scaffold used to help reconstruct selected wounds after skin cancer removal. New tissue and small blood vessels grow into its porous layer. An outer sealing membrane covers the surface while this happens.
It may be considered when a wound cannot be stitched together easily, or when a graft cannot be placed directly on the wound. The decision depends on the wound, its blood supply, your health and the available alternatives.
BTM is made from synthetic material rather than human or animal tissue. It still needs careful wound care and can develop complications, including infection or incomplete integration.
Your reconstruction pathway
At the clinic, some selected BTM wounds are managed with ongoing dressings while the wound gradually closes from its edges. Others need a later skin graft. Your surgeon will explain your intended pathway and may change the plan if healing requires it.
- Direct closure: the edges can be brought together with stitches.
- Local flap: nearby tissue is moved to cover the wound.
- Skin graft: skin from another area covers a suitable wound bed.
- BTM: a scaffold supports new tissue before further closure or ongoing healing.
Each approach involves different scars, recovery times and appointments. Natural closure can take several months and is not suitable for every wound.
Preparing for BTM surgery
Bring a current list of medicines, vitamins and supplements, and tell us about allergies to medicines, latex, antiseptics or dressings. Let the team know about diabetes, circulation problems, previous healing difficulties or a tendency to develop thick scars.
Do not stop blood thinners or change prescribed medicines without advice from your treating team. This includes prescribed aspirin. Ask about any medicine instructions before your appointment.
For a procedure under local anaesthetic alone, fasting is usually not needed unless you have been told otherwise. If sedation or general anaesthetic is planned, follow the fasting and medicine instructions provided by your hospital or anaesthetic team. Call if these are unclear.
- Bring your Medicare card, relevant referral or test results, and comfortable clothing that gives access to the treatment area.
- Discuss transport home. Arrange a responsible adult after sedation or general anaesthetic. Wound location, pain and movement can affect driving even after local anaesthetic.
- Smoking can slow healing. Ask your GP or the clinic for help stopping before surgery and during recovery.
- Ask about the benefits, risks, alternatives and likely scar before giving consent. You can ask for more time or further explanation.
Plan for regular dressing reviews and help at home if the wound location limits activity. If you live a long way from the clinic, discuss local nursing support and how the surgical team will monitor progress.
Placement and the early days
After the cancer is removed and the wound is prepared, the BTM is shaped to fit and secured, often with staples. A dressing protects it. Before discharge, the team will confirm your dressing instructions and first review.
Leave the first dressing in place until your planned review unless the team tells you otherwise. An early nurse review is commonly arranged at about one week, with another around two weeks. Staples may be removed at the second review if appropriate.
Keep the area protected and dry as instructed. For a lower-leg wound, rest and elevation may be important. Use compression only if it has been prescribed for you.
How healing progresses
First weeks: integration
New tissue and blood vessels gradually grow into the scaffold. The surface may change from pale to pink or red. Your nurse assesses attachment, fluid, surrounding skin and the progress of integration at each visit.
After integration: the sealing membrane
Once the tissue underneath is ready, the clinical team manages removal of the outer membrane. This stage is called delamination. It often occurs after several weeks, but the timing is individual. Do not pull, cut or remove the membrane yourself; contact the clinic if it loosens unexpectedly.
The following weeks and months
The wound may continue to close from its edges with dressings, or your surgeon may recommend a skin graft. Reviews may become less frequent as the wound settles. Closure can take months, especially for large wounds or lower-leg wounds; a particular finish date cannot be guaranteed.
Fluid, slough and changes in appearance can occur during BTM healing. These changes still need clinical assessment: do not assume that odour, discolouration or drainage rules infection in or out. Contact the team for a new or worsening change, particularly with pain, spreading redness or fever.
Care at home and dressing appointments
- Let the nurse perform the early dressing changes and show you exactly when and how home changes may begin.
- Keep the wound dry between changes as directed; avoid soaking or swimming.
- Do not press out fluid, trim the membrane or remove tissue at home.
- Follow your individual elevation and activity plan, particularly for lower-leg wounds.
- Call if the dressing is saturated, loose or damaged. Specialised dressings should be managed according to the clinic’s instructions.
- Attend reviews even if progress seems slow. The team checks healing, adjusts dressings and may take clinical photographs.
After home changes are approved, frequency depends on the amount of fluid and the dressing used. Some wounds need daily changes; others need them less often. The nurse will write down your schedule.
If a skin graft is needed
Once a suitable tissue bed has formed, a thin layer of skin can be taken from a donor site and placed over the BTM-treated wound. The graft and donor site both require their own dressings and reviews. The donor site can be more uncomfortable at first.
Protect the new graft from movement and keep its dressing in place until reviewed. Follow the graft-specific instructions rather than restarting an earlier BTM dressing routine.
Possible problems and longer-term recovery
Problems can include infection, blood or fluid collecting under the BTM, incomplete integration, delayed healing or difficulty with the outer membrane. If a graft is used, some or all of it may fail to take. Further dressings or surgery may be needed.
All skin surgery leaves a scar. The early pink, firm or raised appearance can change over many months; scars may continue to mature for 12–18 months. Wound location, skin type, healing and the procedure all affect the final result.
Only start scar massage or silicone products once the wound is fully closed and your clinician says it is ready. Protect healed skin from the sun and let us know if a scar becomes increasingly raised, tight or uncomfortable.
Read about scars and ongoing skin checks →
A clinician will call you if your results require urgent action. Otherwise, your results will be discussed with you at your follow-up appointment.
Confirm your review appointment before leaving. If it has not been arranged, or your results are taking longer than expected, call the clinic. No contact does not mean a result is clear.
When to seek help
- Increasing or spreading redness, warmth or swelling.
- Pain that is getting worse rather than settling, pus, a new unpleasant smell, fever or feeling unwell.
- A wound that opens, a rapidly growing swelling, or a dressing that is repeatedly soaked.
- An unexpected change in the colour or appearance of a graft, flap or BTM wound.
Call 07 7520 8580 promptly. If the clinic is closed and the problem is urgent, seek an urgent medical assessment. Do not wait for a routine review.
For bleeding, apply firm, continuous pressure with a clean dressing. If bleeding persists despite pressure, seek urgent care. For severe bleeding, collapse or another medical emergency, call 000.
Further reading: PolyNovo: about NovoSorb BTM.
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