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Background

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.

OrthoWrap™ Bioresorbable Protective Sheet

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.

Discussion

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.

Summary

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.

OrthoWrap™ Bioresorbable Protective Sheet

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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