Limb Salvage through Intermediary Wound Coverage with Acellular Dermal Matrix Template after Persistent Pseudomonas Aeruginosa Infection in a Burn Patient

Round 1

Reviewer 1 Report

Review on:“ Limb salvage with acellular dermal matrix template after persistent pseudomonas infection in a trauma patient“ by Gladysz et al.

The present case report is of interest to physicians working in traumatology and burn patient care. A major "plus" of this work is the report on the use of modern procedures in the treatment of a complicated case (NovoSorb BTM). There are few comments, but they should be addressed prior to publication.

• When you know about the bacterial species, please use the correct name througout the manuscript. Pseudomonas is the genus, Pseusdomonas aeruginosa the species that was detected. Generally, all bacterial species should be written in italics (Pseduomonas aeruginosa).
• Introduction: Should it be: „…. suffered from a deep partial …“ Please correct this.
• Please outline why antibiotics were not given.
• What was the rationale for the administration of bacteriophages. What criteria were used to select the phages? Isn't that more of an experimental approach? Please comment on this.
• Please provide detailed information on how the species Pseduomonas aeruginosa was identified.

Author Response

Please see the attachment.

With regards,

Mateusz Gładysz 

Author Response File: Author Response.pdf

Reviewer 2 Report

Dear Authors, thank you for this interesting case.

Overall, BTM seems to be an interesting product for difficult wounds. Nevertheless, I do have a few questions regarding your case report.

1. Please check spelling and grammar. Especially in the abstract there are a number of mistakes.
2. Which topical agent did you use initially to treat the pseudomonas? Did you give the patient antibiotics against pseudomonas? 
3. Why did you apply Mafenid so late? Is this the SOC in your clinic?
4. If the therapy with Mafenid and regular dressing changes wound have been performed earlier and the second skin grafting later then you might not have lost the second skin grafts and tendons might not have been exposed through numerous debridements. Please explain in the discussion part.
5. There are a number of publications (case series and studies) on BTM for wound coverage of complex wounds, please cite and explain what is new/different in your case?

Author Response

Please see the attachment.

With regards,

Mateusz Gładysz 

Author Response File: Author Response.pdf

Reviewer 3 Report

Authors should discuss that NovoSorb BTM has a possibility especially strong against infection. In my personal impression, infection control is depending on enough debridement and anti-infection agents, and not depending on scaffold. In this meaning, autologous skin graft and cadaver skin graft is better than artificial scaffold. If this discussin is missing,  the title of the article seems not to be appropriate. Because, the title suggested that NovoSorb BTM is especially effective for infection.

Author Response

Please see the attachment.

With regards,

Mateusz Gładysz 

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

I think the paper was revised appropriately.