Efficacy and safety of Dynavisc® gel in prevention of scar adhesions recurrence after flexor tendons tenolysis in zone 2. Multicenter retrospective cohort study.

AIM: Dynavisc® is a novel surgical product made of carboxymethylcellulose (CMC) and Polyethylene Oxide (PEO) designed to reduce post-surgical adhesions in tendons surgery. A multicenter retrospective cohort study was performed to investigate the clinical safety and efficacy of the Dynavisc® gel in reducing post-surgical adhesions after flexor tenolysis in zone 2. MATERIAL OF STUDY: Thirty-one patients suffering from stiff finger after flexor tendon repairs in zone 2 treated with standard release with (18 Dynavisc®-treated group) or without (13 controls) anti-adhesion gel application into the flexor tendon sheath and around the site of the tenolysis, were collected in five different hand surgery units. Safety profile and functional outcomes (based on TAM test and the The Quick-DASH questionnaire) were examined from patients' charts and analyzed. RESULTS: The application of Dynavisc® posed no safety concerns and it was not related to any additional complication. The Dynavisc®-treated group showed greater progressive improvement of TAM value in all visits with superior TAM value at T(90) and T(180) compared to the control group. DISCUSSION: Tendon adhesions are the main cause of flexor tendon surgery failure. Multiple strategies (i.e. robust tendon repair, early rehabilitation and lubricant or barrier agents) have been proposed to minimize their formation. Among different products described in the literature Dynavisc® showed a significant role in limiting adhesions formation in a recent experimental study. CONCLUSIONS: This clinical study confirm the safety of Dynavisc® gel application in hand surgery demonstrating its potential long-term benefits after flexor tendon tenolysis. KEY WORDS: Flexor Tendon Repair, Tendon Adhesions, Tenolysis.

Multiple ruptures of the extensor tendons after volar fixation for distal radius fracture: a case report.

A 62-year-old woman was admitted to our hospital after a bicycle accident with a displaced left (non-dominant) distal radius fracture. After closed reduction a long cast was applied. Due to loss of reduction, twenty-four days later open reduction internal fixation with locking compression plate (LCP) was performed. The patient returned to her normal activities but nineteen months after surgery showed functional impairment of the left thumb for Extensor Pollicis Longus (EPL) injury for which she necessitated transposition surgery. Twenty-six months after ORIF, functional deficit of the extension of the third and fourth left finger was noted secondary to injury of extensor tendons. Ultrasound and CT scan showed protrusion of the angular stability screws in LCP plate that caused a progressive wear resulting in rupture of the extensor tendons. Another tendon transposition surgery was performed with dorsal approach while the plate was removed utilising the original volar incision. Reconstruction of distal radius fractures with volar plating, requires accurate plate application with precise measurement of the length of the screws in order to prevent dorsal protrusion and thus avoiding tendon injuries.