Novel use of a flowable collagen-glycosaminoglycan matrix (Integra™ Flowable Wound Matrix) combined with percutaneous cannula scar tissue release in treatment of post-burn malfunction of the hand--A preliminary 6 month follow-up.

INTRODUCTION: 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. PATIENTS AND METHODS: 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. RESULTS: 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. DISCUSSION: 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.

[Deformities around the knee after growth plate injuries: Analysis and correction]. / Kniegelenknahe Deformitäten nach Epiphysenverletzungen: Analyse und Korrektur.

INTRODUCTION: Growth plate injuries of the distal femur and the proximal tibia are rare, but may induce deformities around the knee. The type of primary injury and the patient's age at the time of injury influence the extent and complexity of the deformity. PATIENTS AND METHODS: Twelve patients (median age = 12 years; range = 7-16 years) experienced growth plate injuries of the knee, followed by post-traumatic deformities. In fully developed growth plates, the deformities were subjected to a comprehensive and standardized analysis. Eleven patients had deviations in the frontal plane and 9 patients in the sagittal plane. Ten patients had relevant length differences and 7 patients had torsional deviations. One of the deformities was unidimensional, one was two-dimensional, six were three-dimensional, and four were four-dimensional. Ten corrective osteotomies were performed in the femoral aspect and 5 in the tibial aspect. Three patients needed bifocal osteotomies. Eight osteotomies were performed with an oscillating saw and 7 osteotomies with a drill hole and chisel. Acute correction could be achieved in 4 cases and continuous correction by means of callus distraction in 5 cases, whereas 3 patients needed combined procedures. RESULTS: One arterial injury had to be treated immediately by performing acute vascular surgery. A pin tract infection healed after early removal of the external fixator for distraction. Delayed bone healing necessitated a local revision with cancellous bone grafting. The goals of correction and acceptable knee function were achieved in all patients. CONCLUSION: Growth plate injuries frequently cause very complex deformities. A comprehensive and structured analysis of the deformity and customized acute/continued corrective procedures are essential for a satisfactory anatomic and functional outcome.

WITHDRAWN: The extended abdominal wall flap for transplantation.

INTRODUCTION: Patients with extensive loss of abdominal wall tissue have few options for restoring the abdominal cavity. Composite tissue allotransplantation has been used for limited abdominal wall reconstruction in the setting of visceral transplantation, yet replacement of the entire abdominal wall has not been described. The purpose of this study was to determine the maximal abdominal skin surface available through an external iliac/femoral cuff-based pedicle. MATERIALS AND METHODS: Five human cadaver abdominal walls were injected with methylene blue to analyze skin perfusion based on either the deep inferior epigastric artery (DIEA; n = 5) or a cuff of external iliac/femoral artery (n = 5) containing the deep circumflex iliac, deep inferior epigastric, superficial inferior epigastric, and the superficial circumflex iliac arteries. RESULTS: Abdominal wall flaps were taken full thickness from the costal margin to the mid-axial line and down to the pubic tubercle and proximal thigh. In all specimens, the deep inferior epigastric, deep circumflex iliac, superficial inferior epigastric, and the superficial circumflex iliac arteries were found to originate within a 4-cm cuff of the external iliac/femoral artery. Abdominal wall flaps injected through a unilateral external iliac/femoral segment had a significantly greater degree of total flap perfusion than those injected through the DIEA alone (76.5 +/- 4% versus 57.2 +/- 5%; Student t test, P < .05). CONCLUSIONS: Perfusion of a large portion of the abdominal wall is possible using single-vessel anastomosis through a short segment of the external iliac/femoral system. Perfusion is significantly greater than that based on the DIEA vessel alone.

The extended abdominal wall flap for transplantation.

INTRODUCTION AND AIMS: Patients with extensive loss of the abdominal wall tissue have few options for restoring the abdominal cavity. Composite tissue allotransplantation has been used for limited abdominal wall reconstruction in the setting of visceral transplantation, yet replacement of the entire abdominal wall has not been described. The purpose of this study was to determine the maximal abdominal skin surface available through an external iliac/femoral cuff-based pedicle. MATERIALS AND METHODS: Five human cadaveric abdominal walls were injected with methylene blue to analyze skin perfusion based on either the deep inferior epigastric artery (DIEA; n = 5) or a cuff of external iliac/femoral artery (n = 5) containing the deep circumflex iliac, deep inferior epigastric, and superficial inferior epigastric, and superficial circumflex iliac arteries. RESULTS: Abdominal wall flaps were taken full thickness from the costal margin to the midaxillary line and down to the pubic tubercle and proximal thigh. In all specimens, the deep inferior epigastric, deep circumflex iliac, superficial inferior epigastric, and superficial circumflex iliac arteries were found to originate within a 4-cm cuff of the external iliac/femoral artery. Abdominal wall flaps injected through a unilateral external iliac/femoral segment had a significantly greater degree of total flap perfusion than those injected through the DIEA alone (76.5% ± 4% vs 57.2% ± 5%; Student t test, P < .05). CONCLUSIONS: Perfusion of a large portion of the abdominal wall is possible using a single-vessel anastomosis through a short segment of the external iliac/femoral system. Perfusion is significantly greater than that based on the DIEA vessel alone.