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Liu H, Liu J, Wu YW, Zhou M, Rui YJ. Clinical efficacy of the topical application of tranexamic acid in tendon release in the hand: A randomized controlled trial. Chin J Traumatol 2024; 27:163-167. [PMID: 38216434 PMCID: PMC11138941 DOI: 10.1016/j.cjtee.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 01/14/2024] Open
Abstract
PURPOSE To study the clinical effectiveness of the topical application of tranexamic acid in hand tendon release. METHODS This was a randomized controlled trial conducted after receiving approval from the local ethics committee according to guidelines from the Helsinki Declaration. Eighty patients who underwent hand tendon release operation in our hospital from January 2021 to December 2022 were included and randomly divided into 2 groups. Patients in the tranexamic acid group (40 cases) received intraoperative topical application of 2 g of tranexamic acid after tendon release, while patients in the conventional group (40 cases) did not receive topical application of tranexamic acid during operation. The operation time, perioperative hemoglobin changes, total blood loss, incidence of early postoperative complications, and total active movement (TAM) before surgery and 6 months after surgery were compared between the 2 groups. The continuous variable which follows normal distribution expressed by mean ± SD and used t-test to compare between groups. Meanwhile, categorical variables were used by Chi-square test, and a p < 0.05 indicated that the differences were statistically significant. RESULTS Both groups were followed up for 7 - 18 months, with a mean of 10.3 months. Postoperative decrease in hemoglobin was significantly less in the tranexamic acid group than in the conventional group (t = 7.611, p < 0.001). The total blood loss in the tranexamic acid group (74.33 ± 20.50) mL was less than that in the conventional group (83.05 ± 17.73) mL, and the difference was statistically significant (p < 0.05). Both groups showed improvement in thumb/finger flexion and extension range of motion after surgery, and the TAM improved compared with those before surgery, and the difference was statistically significant (p < 0.001). The TAM improved more significantly in the tranexamic acid group (87.68° ± 10.44°) than in the conventional group (80.47° ± 10.93°) at 6 months after surgery, with a statistically significant difference (t = 3.013, p < 0.001). There was no significant difference in operation time and incidence of early postoperative complications between the 2 groups (p = 0.798, 0.499, respectively). CONCLUSION The topical application of tranexamic acid during hand tendon release can significantly reduce postoperative bleeding and improve surgical efficacy, which is worth promoting.
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Affiliation(s)
- Hao Liu
- Suzhou Medical College of Soochow University, Suzhou, 215000, Jiangsu province, China; Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, 214000, Jiangsu province, China
| | - Jun Liu
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, 214000, Jiangsu province, China
| | - Yong-Wei Wu
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, 214000, Jiangsu province, China
| | - Ming Zhou
- Suzhou Medical College of Soochow University, Suzhou, 215000, Jiangsu province, China; Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, 214000, Jiangsu province, China
| | - Yong-Jun Rui
- Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, 214000, Jiangsu province, China.
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Autologous Fat Grafting in the Upper Extremity: Defining New Indications. Plast Reconstr Surg Glob Open 2022; 10:e4469. [PMID: 35999879 PMCID: PMC9390829 DOI: 10.1097/gox.0000000000004469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 06/03/2022] [Indexed: 11/26/2022]
Abstract
Autologous fat grafting is a commonly used technique in plastic surgery that can also be applied broadly in hand surgery. We present a case series to demonstrate the diverse indications for fat grafting in hand surgery. Methods We retrospectively reviewed cases of fat grafting in the upper extremity in 2020. Cases representing a unique application of fat grafting were identified. Patient data, including demographics, diagnoses, preoperative and postoperative assessments, complications, patient satisfaction, and surgical operative reports, were recorded. Results Five patients representing distinct indications for autologous fat grafting in the upper extremity were identified. Indications included hand rejuvenation (20.0%), burn/scar management (20.0%), tenolysis (20.0%), revision nerve decompression (20.0%), and carpometacarpal joint arthritis (20.0%). Average patient age was 60.4 years (range, 42-71). Average volume of fat injected was 15.2 ml (range, 1-37 ml). No major complications were noted (0.0%). All patients expressed satisfaction with their overall result with good functional outcomes (100%). Conclusions Autologous fat grafting can be applied broadly in hand surgery. Indications for fat grafting in hand surgery include hand rejuvenation, burn/scar management, tenolysis, revision nerve decompression, and thumb carpometacarpal arthritis. Hand surgeons can easily incorporate fat grafting into their daily practice. Current literature supports fat grafting as a viable technique in hand surgery with lower-level studies.
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Miller TJ, Lin WC, Watt AJ, Sheckter CC. Bilaminate Synthetic Dermal Matrix versus Free Fascial Flaps: A Cost-Effectiveness Analysis for Full-Thickness Hand Reconstruction. J Reconstr Microsurg 2021; 37:551-558. [PMID: 33486748 DOI: 10.1055/s-0040-1722761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Full-thickness injuries to the hand require durable soft tissue coverage to preserve tendon gliding and hand motion. We aim to investigate the cost effectiveness of hand resurfacing comparing free fascial flap reconstruction versus bilaminate synthetic dermal matrices. METHODS Cost effectiveness was modeled using decision tree analysis with the rollback method. Total active range of motion was modeled as the common outcome variable based on systematic literature review. Costing was performed from a payer perspective using national Medicare reimbursements. The willingness to pay threshold was determined by average worker's compensation for hand disability. Probabilistic sensitivity analysis was conducted for range of motion outcomes and the costs using 10,000 Monte Carlo simulations. RESULTS The average cost of free fascial flap reconstruction was $14,201.24 compared with $13,674.20 for Integra, yielding an incremental cost difference of $527.04. Incremental range of motion improvement was 18.0 degrees with free fascial flaps, yielding an incremental cost effectiveness ratio of $29.30/degree of motion. Assuming willingness to pay thresholds of $557.00/degree of motion, free-fascial flaps were highly cost effective. On probabilistic sensitivity analysis, free fascial flaps were dominant in 25.5% of simulations and cost effective in 32.1% of simulations. Thus, microsurgical reconstruction was the economically sound technique in 57.5% of scenarios. CONCLUSION Free fascial flap reconstruction of complex hand wounds was marginally more expensive than synthetic dermal matrix and yielded incrementally better outcomes. Both dermal matrix and microsurgical techniques were cost effective in the base case and in sensitivity analysis. In choosing between dermal matrix and microsurgical reconstruction of complex hand wounds, neither technique has a clear economic advantage.
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Affiliation(s)
- Travis J Miller
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California.,The Buncke Clinic, San Francisco, California
| | | | | | - Clifford C Sheckter
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California
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Di Nicola V. Omentum a powerful biological source in regenerative surgery. Regen Ther 2019; 11:182-191. [PMID: 31453273 PMCID: PMC6700267 DOI: 10.1016/j.reth.2019.07.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/24/2019] [Indexed: 02/06/2023] Open
Abstract
The Omentum is a large flat adipose tissue layer nestling on the surface of the intra-peritoneal organs. Besides fat storage, omentum has key biological functions in immune-regulation and tissue regeneration. Omentum biological properties include neovascularization, haemostasis, tissue healing and regeneration and as an in vivo incubator for cells and tissue cultivation. Some of these properties have long been noted in surgical practice and used empirically in several procedures. In this review article, the author tries to highlight the omentum biological properties and their application in regenerative surgery procedures. Further, he has started a process of standardisation of basic biological principles to pave the way for future surgical practice.
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del Piñal F, Moraleda E, de Piero GH, Ruas JS. Outcomes of free adipofascial flaps combined with tenolysis in scarred beds. J Hand Surg Am 2014; 39:269-79. [PMID: 24480687 DOI: 10.1016/j.jhsa.2013.11.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 11/17/2013] [Accepted: 11/18/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To review our outcomes of transferring vascularized free adipofascial flaps used to change the local tissue conditions at the time of tenolysis in adhesion-prone beds. METHODS Eleven free adipofascial flaps were transplanted in 10 patients after tenolysis on the forearm (3 cases), the dorsum of the hand (5 cases), or the dorsum of the proximal phalanx (3 cases). All recipient areas had badly scarred beds, 7 of which had previously failed tenolyses. In addition to tenolysis (10) or the insertion of bridging tendon grafts (1), arthrolysis of several involved joints and bone fixation for nonunion (3 cases) were carried out simultaneously. The adipofascial flap was then wrapped around the tendons or interposed between the scarred tissue and the freed tendons. In 8 cases, the flap was the lateral arm adipofascial flap, whereas adipose flaps from the toes were used for the fingers. RESULTS All flaps survived without vascular crisis. In all cases, total active motion was similar to the passive motion obtained at surgery. Average Disabilities of the Arm, Shoulder, and Hand score improved from 69 to 10, and average Patient-Rated Wrist Hand Evaluation score improved from 65 to 9. Secondary surgery was needed to reduce the bulk of the flap in 3 patients. One patient required an additional procedure to obtain an optimum result. CONCLUSIONS Free adipofascial flaps provided satisfying results in this group of patients. The flaps should be considered when the bed is scarred or after a failed tenolysis. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Francisco del Piñal
- Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain.
| | - Eduardo Moraleda
- Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain
| | - Guillermo H de Piero
- Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain
| | - Jaime S Ruas
- Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain
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Lui TH. Endoscopic adhesiolysis for extensive tibialis posterior tendon and Achilles tendon adhesions following compound tendon rupture. BMJ Case Rep 2013; 2013:bcr-2013-200824. [PMID: 24045762 DOI: 10.1136/bcr-2013-200824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tendon adhesion is one of the most common causes of disability following tendon surgery. A case of extensive peritendinous adhesions of the Achilles tendon and tibialis posterior tendon after compound rupture of the tendons was reported. This was managed by endoscopic adhesiolysis of both tendons. The endoscopic approach allows early postoperative mobilisation which can relieve the tendon adhesion.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong, Hong Kong
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Damgaard OE, Siemssen PA. Lipografted tenolysis. J Plast Reconstr Aesthet Surg 2010; 63:e637-8. [DOI: 10.1016/j.bjps.2010.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 02/01/2010] [Indexed: 11/25/2022]
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Yilmaz E, Avci M, Bulut M, Kelestimur H, Karakurt L, Ozercan I. The effect of seprafilm on adhesion formation and tendon healing after flexor tendon repair in chicken. Orthopedics 2010; 33:164-70. [PMID: 20349872 DOI: 10.3928/01477447-20100129-16] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Adhesion of the tendon, which can occur during healing of tendon repair, is negatively affected by the outcome of surgery. In this experimental study, we sought to prevent adhesion of the tendon, and determined the mechanical stiffness of repair tissue by wrapping sodium hyaluronate and carboxymethylcellulose (Seprafilm; Genzyme, Cambridge, Massachusetts) around the repaired tendon segments. The study group comprised 2 groups of 20 chickens. In group I, the right gastrocnemius tendons of the chickens were cut smoothly, and after tendon and sheath repair, the skin was sutured. In group II, the right gastrocnemius tendons of the chickens were cut, the tendons were repaired, and before skin closure, Seprafilm was wrapped around the repaired tendon segments. Plastic splints were used for holding the chickens' ankles in a neutral position, and they were allowed weight bearing for 8 weeks. In group II, anatomic space between the tendon-sheath and tendon was clear and the tendon-sheath complex was sliding easily around the repaired tendon segment, and this complex was more functional both biomechanically and histologically. Also, the Seprafilm-applied tendons (group II) were observed to be biomechanically more resistant to the tensile forces in group I. Seprafilm is an easily applied interpositional material that can be used safely to prevent adhesion during the tendon healing process.
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Affiliation(s)
- Erhan Yilmaz
- Department of Orthopedics and Traumatology, Firat University, Elazig, 23200, Turkey.
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Free serratus anterior fascia flap for reconstruction of hand and finger defects. Arch Orthop Trauma Surg 2010; 130:217-22. [PMID: 19271229 DOI: 10.1007/s00402-009-0845-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Reconstruction of the dorsal surface of hand defects requires thin, pliable, well vascularized tissue with a gliding surface for the extensor tendon course. Also defects of the palmar hand and degloved fingers need non-bulky soft tissue for reconstruction. We present a retrospective analysis of nine patients with free serratus anterior fascia flaps used to cover defects of the palmar and dorsal hand and of degloved fingers. METHODS Three of the patients presented limited range of hand motion due to full-thickness burns; one patient had defects of the dorsum of one hand after acute burn injury. Two patients had an acute trauma of the dorsum of the hand with extensor tendon injury, another patient a soft-tissue defect of his thumb and dorsal hand due to an avulsion injury. One patient presented dorsal defect of three fingers after degloving injury. One patient had a palmar defect after industrial crush injury with exposed tendons, vessels, and nerves. The flaps were applied as pure fascial flaps with an immediate partial-thickness skin graft. RESULTS One patient presented a partial necrosis of <10% flap size. All other flaps survived completely. Two of the patients presented wound healing problems of the skin graft that healed secondarily. All patients recovered useful hand function without a bulky contour of their hand or fingers. Except for the scar, no donor-site morbidity was reported. CONCLUSION The free serratus anterior fascia flap has good functional and cosmetic properties and there is low donor-site morbidity. It is an excellent flap for soft-tissue reconstruction combined with extensor tendon reconstruction on the dorsum of the hand. The flap is also very useful for palmar and finger defects.
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McCombe D, Brown T, Slavin J, Morrison WA. The histochemical structure of the deep fascia and its structural response to surgery. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 2001; 26:89-97. [PMID: 11281657 DOI: 10.1054/jhsb.2000.0546] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The histochemical structure of the deep fascia and its interface with the underlying muscle was examined in ten pigs. This structure was also evaluated after it had been raised as a fascial flap and in another site after the underlying muscle surface had been disrupted. The deep fascial is a simple structure of densely-packed collagen bundles and elastin fibres, and has hyaluronic acid concentrated on its inner surface, which is in contact with the underlying muscle. There is no specialised lining of this surface of the fascia to account for its gliding properties. The post-surgical specimens demonstrated preservation of the structure of the interface between fascia and muscle, including the retention of the hyaluronic acid lining, if the epimysium was intact. However, if the epimysium was disrupted, the structure of the interface was obliterated.
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Affiliation(s)
- D McCombe
- Department of Biochemistry, Bernard O'Brien Institute of Microsurgery, St.Vincent's Hospital, Monash University, Melbourne, Australia
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Pedicled omental flap and skin grafting to cover artificial mesh. EUROPEAN JOURNAL OF PLASTIC SURGERY 1997. [DOI: 10.1007/bf01002052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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