chondroitin-sulfates and Hand-Injuries

Complex hand injuries are those that involve significant soft-tissue loss with variable exposure of bones and/or joints, lacerated tendons, and neurovascular structures. Management of these injuries is optimally accomplished through the restoration of thin, pliable, ideally sensate tissue with reliable vascularity and a gliding surface to facilitate restoration of motion after repair. Unfortunately, optimal restoration may require complex surgical reconstruction and/or staged surgical procedures. This article presents an overview of some of the more commonly used options available to the reconstructive surgeon willing to tackle these difficult clinical cases.

Topics: Chondroitin Sulfates; Collagen; Hand Injuries; Humans; Plastic Surgery Procedures; Skin Transplantation; Surgical Flaps; Tendon Injuries; Tendon Transfer

Surgeons and scientists have been developing alternative methods of hand reconstruction that may play an adjunctive role to, or completely supplant, more traditional reconstructive modalities. This article provides an overview of these emerging techniques, with an emphasis on skin substitutes and negative-pressure wound therapy as they apply to the treatment of soft tissue defects of the hand. The indications, contraindications, and relative advantages and disadvantages of these techniques are discussed in detail.

Topics: Bandages; Blast Injuries; Chondroitin Sulfates; Coated Materials, Biocompatible; Collagen; Hand Injuries; Humans; Negative-Pressure Wound Therapy; Occlusive Dressings; Plastic Surgery Procedures; Skin, Artificial; Soft Tissue Injuries; Wound Healing

Several skin substitutes are available that can be used in the management of hand burns; some are intended as temporary covers to expedite healing of shallow burns and others are intended to be used in the surgical management of deep burns. An understanding of skin biology and the relative benefits of each product are needed to determine the optimal role of these products in hand burn management.

Topics: Bioengineering; Burns; Chondroitin Sulfates; Coated Materials, Biocompatible; Collagen; Hand Injuries; Humans; Occlusive Dressings; Skin, Artificial; Transplantation, Homologous; Treatment Outcome

Few studies have been conducted to explore the utility of the Integra. We retrospectively reviewed all patients treated by IDRT combined with STSG from May 2015 to October 2018. The inclusion criterion was traumatic or post-infectious soft tissue defects (STDs) of the dorsal hand, fingers, and thumb, not suitable for direct wound closure and requiring local, pedicle, or free flap reconstruction. After debridement, a two-stage procedure was applied, namely IDRT followed by STSG. Indications, functional outcomes, aesthetic results, complications, patient satisfaction, and the STSG take rate were evaluated over a 36-month follow-up using standardised instruments.. The 36-month follow-up demonstrated that IDRT is a safe and reliable technique that can be considered a viable alternative to flap reconstruction for the management of traumatic STDs in selected patients. The aesthetic outcomes are acceptable, functional recovery of the fingers is excellent, patient satisfaction is very high and the rate of complications is very low.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Chondroitin Sulfates; Cicatrix; Collagen; Debridement; Esthetics; Female; Finger Injuries; Fingers; Hand; Hand Injuries; Humans; Male; Middle Aged; Patient Satisfaction; Physical Appearance, Body; Plastic Surgery Procedures; Retrospective Studies; Skin Transplantation; Soft Tissue Injuries; Thumb; Treatment Outcome; Wound Infection; Young Adult

Despite extensive use of Integra in burn reconstruction, little has been published regarding its utility in complex hand wounds from nonburn trauma or cancer resection. This study aimed to review outcomes following Integra use for hand reconstruction following cancer resection or nonburn trauma with exposed bone, joints, and/or tendons.. Retrospective review was performed of patients undergoing hand reconstruction with Integra for exposed bones, joints, or tendons over a 6-year period at a single institution.. Fourteen patients underwent hand reconstruction using Integra, 8 following cancer resection and 6 following acute nonburn trauma. The mean defect size was 19 cm. Integra is an effective method to treat complex hand wounds with exposed bone, joints, and/or tendons. This technique can be used in the office, lessens the need for local or free flap coverage, and provides an excellent aesthetic outcome. Integra should be considered a viable option in hand reconstruction algorithm.

Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Chondroitin Sulfates; Collagen; Female; Hand; Hand Injuries; Humans; Male; Melanoma; Middle Aged; Negative-Pressure Wound Therapy; Patient Satisfaction; Retrospective Studies; Skin Neoplasms; Surgical Flaps

Long-term function following severe burns to the hand may be poor secondary to scar adhesions to the underlying tendons, webspaces, and joints. In this pilot study, we report the feasibility of applying a pasty dermal matrix combined with percutaneous cannula teno- and adhesiolysis.. In this 6 month follow-up pilot study, we included eight hands in five patients with hand burns undergoing minimal-invasive, percutaneous cannula adhesiolysis and injection of INTEGRA™ Flowable Wound Matrix for a pilot study of this new concept. The flowable collagen-glycosaminoglycan wound matrix (FCGWM) was applied with a buttoned 2mm cannula to induce formation of a neo-gliding plane. Post treatment follow-up was performed to assess active range of motion (AROM), grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, Vancouver Scar Scale (VSS) and quality of life Short-Form (SF)-36 questionnaire.. No complications were detected associated with the treatment of FCGWM injection. The mean improvement (AROM) at 6 months was 30.6° for digits 2-5. The improvement in the DASH score was a mean of 9 points out of 100. The VSS improved by a mean of 2 points out of 14.. The study demonstrates the feasibility and safety of percutaneous FCGWM for dermal augmentation after burn. Results from this pilot study show improvements in AROM for digits 2-5, functional scores from the patient's perspective (DASH) and scar quality (VSS). The flowable form of established INTEGRA™ wound matrix offers the advantage of minimal-invasive injection after scar release in the post-burned hand with a reduction in the risk of postsurgical re-scarring.

Topics: Adult; Burns; Catheterization; Catheters; Chondroitin Sulfates; Cicatrix; Collagen; Feasibility Studies; Female; Hand Injuries; Hand Joints; Hand Strength; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Pilot Projects; Plastic Surgery Procedures; Range of Motion, Articular; Tissue Adhesions; Treatment Outcome

To assess the results obtained with Integra artificial dermis to cover donor site following the harvesting of pedicle flaps for hand reconstruction.. Between April 2010 and August 2013, 11 patients (8 men and 3 women; mean age, 37 y) were treated with Integra Dermal Regeneration Template (Integra LifeSciences, Inc., Plainsboro, NY) to cover donor defects after raising pedicle flaps for hand and finger reconstruction: radial forearm flap (4 cases), ulnar artery perforator flap (2 cases), and heterodigital island flap (5 cases). After neodermis formation the silicone layer of the artificial dermis was removed (on average after 22 days) and a split- or full-thickness epidermal autograft placed.. No infections, hematoma, or bleeding were recorded during the entire phase in which the artificial skin was applied. Two patients experienced a partial skin graft loss. Median follow-up was 20 months, and results included an average Vancouver Scar Scale rating of 2.7 and an average DASH score of 39. There were no cases of graft adherence to the underlying tendons or muscles.. Favorable cosmetic and functional outcomes were obtained using a dermal regeneration template for the treatment of donor site defects. Despite the drawback of an additional surgical procedure (secondary skin graft), the use of this artificial skin produced soft-tissue augmentation and graft-skin quality, reducing donor site morbidity.. Therapeutic IV.

Topics: Adult; Chondroitin Sulfates; Collagen; Female; Follow-Up Studies; Guided Tissue Regeneration; Hand Injuries; Humans; Male; Middle Aged; Skin Transplantation; Surgical Flaps; Tissue and Organ Harvesting; Transplant Donor Site; Treatment Outcome; Young Adult

The purpose of this manuscript is to document results and complications of use of a regenerative dermal matrix skin substitute for coverage of extremity wounds. A retrospective review at 3 institutions identified 28 patients and 34 wounds who had undergone use of this material (Integra). Complications included failure in two patients (4 wounds). However, overall "take" of the regenerative matrix was 86.1%. In most cases, a split thickness skin graft was applied on average at 25 days following the initial procedure. Failures were associated with infection and irradiation of the surgical field. In this series, use of the dermal regenerative matrix was associated with a high rate of success for wound coverage, obviating the need for flap coverage or prolonged dressing changes in most cases. Further series are likely to refine the known indications and contraindications to use of this method.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arm Injuries; Chondroitin Sulfates; Cohort Studies; Collagen; Extremities; Female; Hand Injuries; Humans; Leg Injuries; Male; Middle Aged; Retrospective Studies; Skin Transplantation; Treatment Outcome; Wounds and Injuries; Young Adult

Dermal substitutes, such as Integra(®) introduced as a new alternative to our surgical arsenal and its use in burn treatment, in both acute and chronic phases, have gained great importance.. The aim of the experiment is to describe the results of the functional evaluation of patients with burned hands treated with Integra(®) in both acute and chronic phases.. A retrospective review of a transversal cohort. Patient characteristics evaluated were sociodemographic characteristics, burn mechanism, burn extension and depth, treatments received previous to Integra(®) and complications related to its use. Clinical and photographic evaluations were performed evaluating skin elasticity, range of articular movement, prehensile strength, pain and functional evaluation using the validated 400 Point Evaluation Test.. A total of 17 burned hands in 14 right-handed patients, were treated with Integra(®), three being bilateral hand burns. Eleven were treated in the acute phase and in nine in the scar reconstruction phase. Range of articular motion was complete in 15 of 17 hands. In 88% of the hands, flexible skin coverage was achieved. No statistically significant difference was observed in prehension strength of the burned hand versus the contralateral non-burned hand. Sixteen hands had a painless evolution. The 400 Point Evaluation score was 92.8 ± 6.3% (80 - 100%). Nearly four-fifths (79%) of the patients returned to normal active working activities.

Topics: Adult; Aged; Burns; Chondroitin Sulfates; Collagen; Female; Follow-Up Studies; Hand; Hand Injuries; Humans; Male; Middle Aged; Plastic Surgery Procedures; Recovery of Function; Retrospective Studies; Skin, Artificial; Treatment Outcome; Wound Healing; Young Adult

Topics: Chondroitin Sulfates; Collagen; Dermatologic Surgical Procedures; Hand; Hand Injuries; Humans; Skin; Skin, Artificial; Upper Extremity; Wounds and Injuries

Hand injuries have major psychological, social and professional repercussions. Treatment of burned hands is suggested to be early and optimal to avoid catastrophic consequences and allow social and professional rehabilitation. Our study analyses the long-term results obtained with Integra(®), a dermal substitute used for the treatment of deep burns of the hands.. A total of 29 hands were treated with Integra(®). Long-term monitoring was performed on 12 hands with a clinical, ultrasonographic and elastometric study. The results were compared with those from a series of healthy hands. This study, with a low number of subjects, is a pilot report.. This study showed a low complication rate, with a high percentage of engraftment of thin skin, and good cosmetic and functional quality. The thickness and viscoelasticity of the skin treated with Integra(®) in our series appeared to be similar to those of healthy skin.. Integra(®) artificial skin is an attractive alternative in the treatment of deep burns of the hand and can achieve results with aesthetic and functional characteristics that are close to those of healthy skin.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Burns; Chondroitin Sulfates; Collagen; Elasticity; Female; Follow-Up Studies; Hand Injuries; Humans; Male; Middle Aged; Pilot Projects; Plastic Surgery Procedures; Retrospective Studies; Skin; Treatment Outcome; Ultrasonography

Authors report the application of Integra dermal regeneration matrix in 10 patients in 12 indications (ages 25-74 years, 6 female and 4 male patients). The smallest reconstructed area was 6 cm2, the largest was 500 cm2. Skin coverage was needed on the lower arm in two patients, on the lower arm and the hand in two patients and on the hand in six patients. Skin grafting onto the neodermis was made on days 19-25. The take rate of Integra was equal or higher than 97%, and the take rate of the skin graft was equal or higher than 90%. Integra dermal regeneration template proved to be suitable for the management of complex wounds on the hands and upper extremities.

Topics: Adult; Aged; Biocompatible Materials; Chondroitin Sulfates; Collagen; Dermatologic Surgical Procedures; Female; Forearm Injuries; Hand Injuries; Humans; Male; Middle Aged; Plastic Surgery Procedures; Regeneration; Skin; Skin Transplantation; Skin, Artificial; Time Factors; Treatment Outcome; Wound Healing

We report our experience with the use of Integra® for the management of severe traumatic wounds of the hand. Fifteen patients were treated with follow-up ranging from 10 to 37 months. Wounds were associated with an osseous and/or joint and/or tendon exposure. Following Integra® placement, patients were managed with dressings and subsequent split-thickness skin grafting an average of 26 days later. Integra® was successful in achieving durable, functional and aesthetic definitive coverage in 13 of 15 applications while allowing a satisfying pollicidigital prehension. Regarding our clinical experience, Integra® is an effective technique to deal with severe wounds of the hand with exposed tendon and/or bone and/or joint, even in the absence of paratenon or periosteum. This can potentially lessen the need for local rotational or free flap coverage and should be taken into consideration as a viable alternative in traumatic reconstruction of the hand.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Chondroitin Sulfates; Cohort Studies; Collagen; Hand Injuries; Hand Strength; Humans; Male; Middle Aged; Plastic Surgery Procedures; Recovery of Function; Retrospective Studies; Treatment Outcome; Wound Healing; Young Adult

Authors performed successful skin replacement with Integra, a dermal regeneration template, on a patient with circumferential avulsion injury including the elbow region and the dorsum of the hand. The take rate of Integra was 97%, followed by a 98% take rate of the split thickness mesh graft used for final wound coverage. Treatment modality provided excellent aesthetic and functional results, underlining the role of Integra in cases of extensive traumatic skin and soft tissue deficit, such as the treatment of avulsion injury.

Topics: Aged; Chondroitin Sulfates; Collagen; Dermatologic Surgical Procedures; Elbow; Elbow Injuries; Esthetics; Female; Hand Injuries; Humans; Plastic Surgery Procedures; Skin; Skin Transplantation; Treatment Outcome; Upper Extremity

Reconstruction was performed on the back of a hand following a poorly managed septic hand injury leading to skin and extensor apparatus necrosis using a reverse radial forearm fasciocutaneous flap and a bilayer artificial skin substitute.. Authors report on the first Hungarian case using Integra dermal regeneration template. Integra was placed on the back of the hand on an area left uncovered by the reverse radial forearm fasciocutaneous flap as well as on the flap harvest area. After biointegration of the regeneration template, the outer silicon layer was removed and a split thickness skin graft was applied.. The take-rate on the donor area was 100% for Integra and 99% for the skin graft, and 90% for both Integra and the skin graft on the back of the hand, providing a good functional and aesthetic result.

Topics: Chondroitin Sulfates; Collagen; Dermatologic Surgical Procedures; Hand Injuries; Humans; Male; Middle Aged; Necrosis; Plastic Surgery Procedures; Skin; Skin, Artificial; Surgical Flaps

A case of severe degloving injury to the left hand with complete destruction of the extensor apparatus of the thumb and exposure of the IP joint is presented. The damaged area was resurfaced with the use of the Integra template and the abductor pollicis longus tendon, lengthened with a tendon graft provided by the extensor indicis, and used to restore thumb extension. The transfer was performed through a prefabricated sheath under the Integra resurfaced area in a two-staged procedure. The final result was functional and aesthetically satisfying.

Topics: Amputation, Surgical; Burns; Chondroitin Sulfates; Collagen; Hand Injuries; Humans; Male; Middle Aged; Skin Transplantation; Thumb

Topics: Adult; Burns; Burns, Inhalation; Chondroitin Sulfates; Collagen; Hand Injuries; Humans; Male; Plastic Surgery Procedures; Treatment Outcome

Scars are extremely problematic, especially due to their unstableness, particularly in weight bearing areas (maximum 70% of the stability of normal skin). The use of split-thickness skin grafts or meshed split-thickness grafts frequently produces poor cosmetic and functional results, full thickness skin is only available in small quantities, free tissue transfer creates severe donor site defects and is surgically challenging. INTEGRA Dermal Regeneration Template is a unique technology which allows permanent regeneration of functional autologous dermal tissue and appears as a new alternative to full-thickness skin grafting, skin expansion and even skin flaps for reconstructive surgery. We used the INTEGRA Dermal Regeneration Template in a patient with a scalped left hand and amputated fingers (Fig. 13, Ref. 10).

Topics: Adult; Amputation, Traumatic; Chondroitin Sulfates; Collagen; Dermis; Hand Injuries; Humans; Male; Plastic Surgery Procedures; Regeneration; Skin, Artificial; Surgical Flaps

Adequate acute treatment of the deeply burned hand and any subsequent reconstructive procedures may be hampered by the lack of sufficient suitable graft material and the risks of donor site morbidity and scarring. This investigation was designed to determine the feasibility of treating deep hand burns using a dermal regeneration template. Patients with deep hand burns underwent either acute treatment or reconstructive procedures with Integra dermal regeneration template. Wound sites were first grafted with the dermal regeneration template, and then 2-3 weeks later after neodermis formation the silicone layer of the Integra was removed and a very thin split-thickness epidermal autograft placed. Acute grafting was performed on 15 hands in 11 patients and reconstructive surgery on 14 hands in 11 patients. Median follow-up was 12 months. Integra take was 100% on all treated hands. After acute grafting the wound site skin was flexible and supple and did not adhere to the deeper layers, thus permitting free articular and functional movement. Cosmetic results of acute surgery were judged satisfactory by both patients and surgeons. After reconstructive procedures, significant improvements were achieved in cosmetic status, based on Vancouver Scar Scale (p=0.0002), and in three measures of function, namely, thumb opposition score (p=0.0005), fingertip-to-palm distance (p=0.0039) and prehensile score (p=0.0039). Favourable cosmetic and functional outcomes were consistently attained using a synthetic dermal regeneration template for treatment of deep hand burns either by acute grafting or reconstructive surgery.

Topics: Adolescent; Adult; Aged; Biocompatible Materials; Burns; Child; Chondroitin Sulfates; Collagen; Female; Graft Survival; Hand Injuries; Humans; Male; Middle Aged; Plastic Surgery Procedures; Skin Transplantation; Skin, Artificial; Treatment Outcome; Wound Healing