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The development of postoperative uncontrolled
healing has long caused clinical problems for hand
surgeons in a variety of scenarios. Acute repairs of
either tendons or nerves has often been associated
with the development of exuberant unwanted scar
tissue postoperatively that interferes with function. It
has been a long sought after goal to try to minimize
this scar tissue using a variety of techniques in order
to improve clinical outcome after these types of
surgical interventions. Tenolysis is necessary when
dense scar surrounding a tendon will not allow it
to perform its purported function. Once a tenolysis
has been performed, it is exceedingly difficult
to minimize the amount of recurrent unwanted
scarring since the very procedure itself will generally
lead to some recurrence of that clinical problem.
The surgeon’s goal is to minimize the formation of
binding scar tissue after acute tendon repair as well
as to limit recurrence after tenolysis.
 The OrthoWrap™ Bioresorbable Protective Sheet can
be utilized for the management and protection of
tendon injuries where there has been no substantial
Background
loss of tendon tissue. The OrthoWrap™ sheet
minimizes soft tissue attachments to the device
in case of direct contact with other tissues. It can
be cut with sterile scissors, shaping the material
according to the preference of the surgeon for the
anatomic considerations of the patient and surgical
procedure. The OrthoWrap™
sheet is then sutured into place
using absorbable suture. This
clear sheet allows for good
visualization of the tissues to
ensure proper placement.
However, the mechanical
integrity and handling of the
material is simple and allows
for repositioning as often as
necessary to ensure proper
placement is achieved.
In tendon surgery where either tenolysis is performed
in a tissue bed that could lead to recurrent scarring,
such as an area where one would expect a great
deal of bleeding postoperatively, or after acute
tendon repair where one anticipates significant
post-operative scarring to occur are ideal cases
for the utilization of the OrthoWrap™ Bioresorbable
Protective Sheets. This is particularly the case when
either tenolysis or acute tendon repair is performed
at the forearm or wrist level where surrounding
soft tissues have a greater propensity for scar
tissue formation. The use of
a biologically well-tolerated
protective sheet that separates
opposing tissues around the
treated structure is inherently
advantageous.
Exact clinical usage depends
upon the particular scenario.
At the forearm level, once an
injured tendon is repaired or
tenolysed, a corresponding
portion of the OrthoWrap™
Bioresorbable Protective Sheet
can be utilized. The tendon is then wrapped with
the OrthoWrap™ sheet, essentially creating a
longitudinal tunnel that the tendon sits inside of.
Several resorbable sutures are used to close that
tunnel and maintain the protective environment
of the OrthoWrap™ sheet; one must ensure that
adequate tendon excursion can occur within the
material so that it does not limit function. On the
other hand, dorsal extensor repairs at the hand level
are best treated by laying a sheet of the material
between the repaired tendons, and the overlying
subcutaneous tissues. The Orthowrap™ sheet is
not secured and the skin is simply closed over that
membrane.
The OrthoWrap™ Bioresorbable Protective Sheet has
proven to be a cost effective and inert product. It
can be wrapped around the various tendons in
acute and chronic repairs to help manage and
protect injured tendons while minimizing unwanted
postoperative tissue attachments to the device
that may impede the recovery of the patient.
While early success has been observed, further
investigation is required to determine the efficacy
of the OrthoWrap™ sheet in tendon surgery of
the upper extremity, especially in the hand and
forearm.
The OrthoWrap™ Bioresorbable Protective Sheet can be utilized for the management and protection of tendon
injuries where there has been no substantial loss of tendon tissue. The bioresorbable protective sheet minimizes soft
tissue attachments to the device in case of direct contact with other tissues.
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