Flexor tendon repair with amniotic membrane
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SICOT AWARD PAPERS
Flexor tendon repair with amniotic membrane Saket Prakash 1 & Pulkit Kalra 1 & Anil Dhal 2 Received: 18 July 2020 / Accepted: 23 July 2020 # SICOT aisbl 2020
Abstract Purpose Flexor tendon adhesion to tissues is one of the most frequent complications reported after flexor tendon repair. The human amniotic membrane (HAM) was used to wrap the tendon repair site to decrease fibrotic response and tendon adhesion. Methods A total of 19 patients with flexor tendon injuries were subjected to surgical repair. The repair site was wrapped with human amniotic membrane (HAM) in nine cases. The remaining ten cases served as controls as no HAM wrap was used. The clinical outcome was assessed by pain, range of motion, and pinch strength. The healing of repair was evaluated with highfrequency ultrasound; the biologic response was assessed with two inflammatory mediators, i.e., interleukin-6 and TGF-beta-1. Results HAM wrap cases recorded less pain, higher total active range of motion, and better tendon glide on ultrasonography at follow-up (6–18 months). The levels of serum inflammatory biologic markers decreased in majority of HAM cases whereas they increased in controls at two to six weeks post-operatively. No infection/immune rejection phenomenon was seen in HAM wrap cases. Conclusions HAM wrap around the tendon repair site resulted in quicker function and qualitatively better tendon healing on ultrasound, with a decrease of the biologic response. Keywords Flexor tendon . Human amniotic membrane . High-frequency ultrasound . Interleukin-6 . TGF-beta-1
Introduction Tendon adhesion to tissues, irrespective of the zone of injury [1], is one of the most frequent complications reported after flexor tendon repair. Clinicians, since the first report of Pulvertaft in 1948 [2], have addressed this problem by implementing improved suturing techniques and early functional exercise. Effective solutions preventing this complication are still in research, and 30 to 40% of patients after tendon repair continue to have a limited finger function, since adhesion is difficult to prevent in practice [3]. Thus, reducing this
Level of evidence of study: II Investigation was performed at the Department of Orthopaedics, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India. * Anil Dhal [email protected] 1
Department of Orthopaedics, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India
2
Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
incidence of adhesion without affecting tendon remains a high research focus. According to the mechanisms of tendon adhesion, several methods and materials to prevent tendon adhesion have been proposed as improvement of suturing techniques, early rehabilitation training after operation, and drugs to inhibit inflammatory response have been explored. Chemical agents and physical barriers are current methods proposed to prevent tendon adhesion. Absorbable polymer compounds are those that feature better biocompatibility and biodegradability.
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