Complex Achilles Reconstruction for Massive Soft Tissue Loss: Allograft, Autograft, and Use of a Temporary Cement Spacer

Beals, Timothy C.; Severson, Erik P.; Kinikini, Daniel V.; Aoki, Stephen K.

doi:10.1097/bot.0b013e3181c80a87

Cited by 14 publications

(26 citation statements)

References 12 publications

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“…In such cases, resection of the diseased tissue leads to defect formation [4]. If small, tendon defects could be sutured directly or reconstructed with autogenous tissues [1,2]. However, reconstruction of large tendon defects with autografts has considerable limitations including graft availability and donor site morbidity and this technique requires double surgery [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Role of Embedded Pure Xenogenous Bovine Platelet Gel on Experimental Tendon Healing, Modelling and Remodelling

2014

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Section: Introductionmentioning

confidence: 99%

“…Large Achilles and other tendon injuries could happen due to tumors, traumas, gangrenous and infective ulcers, tendinopathies and several other conditions [1][2][3]. In such cases, resection of the diseased tissue leads to defect formation [4].…”

Section: Introductionmentioning

confidence: 99%

Role of Embedded Pure Xenogenous Bovine Platelet Gel on Experimental Tendon Healing, Modelling and Remodelling

2014

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“…Due to many soft connective tissue tumors such as Xantoma, fibrosarcoma and liposarcoma, gangrenous and infective ulcers, burning, traumatic injuries (e.g. car accident or gunshot trauma), tendinitis or tendinopathy, and neglected Achilles tendon ruptures or chronic ruptures [1], [3]–[10], large tendon defect could occur [6]. In such circumstances it is often necessary to resect the remaining Achilles tendon and reconstruct the defect area [6]–[8].…”

Section: Introductionmentioning

confidence: 99%

“…Tendon transplantation could be a potential method of choice; however due to the large size of the harvesting autograft, the donor site morbidity is a major concern and the allografts due to many reasons such as disease transmission (e.g. HIV), rejection and ethical concerns, have not been widely accepted as yet [1], [2], [7]. For these reasons treatment of such massive tendon injuries is a state of art and depends on the surgeon’s experience, equipment, facilitation, and condition [1], [3], [7].…”

Section: Introductionmentioning

confidence: 99%

“…HIV), rejection and ethical concerns, have not been widely accepted as yet [1], [2], [7]. For these reasons treatment of such massive tendon injuries is a state of art and depends on the surgeon’s experience, equipment, facilitation, and condition [1], [3], [7]. In addition, it should be highlighted that injured tendons have low healing capability and they should tolerate large tensions during the healing process which increase the rate of failure after surgical treatment [5], [12], [13].…”

Section: Introductionmentioning

confidence: 99%

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Tendon Tissue Engineering and Its Role on Healing of the Experimentally Induced Large Tendon Defect Model in Rabbits: A Comprehensive In Vivo Study

2013

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Healing of large tendon defects is challenging. We studied the role of collagen implant with or without polydioxanone (PDS) sheath on the healing of a large Achilles tendon defect model, in rabbits. Sixty rabbits were divided into three groups. A 2 cm gap was created in the left Achilles tendon of all rabbits. In the control lesions, no implant was used. The other two groups were reconstructed by collagen and collagen-PDS implants respectively. The animals were clinically examined at weekly intervals and their lesions were observed by ultrasonography. Blood samples were obtained from the animals and were assessed for hematological analysis and determination of serum PDGF level, at 60 days post injury (DPI). The animals were then euthanized and their lesions were assessed for gross and histopathology, scanning electron microscopy, biomechanical testing, dry matter and hydroxyproline content. Another 65 pilot animals were also studied grossly and histopathologically to define the host implant interaction and graft incorporation at serial time points. The treated animals gained significantly better clinical scoring compared to the controls. Treatment with collagen and collagen-PDS implants significantly increased the biomechanical properties of the lesions compared to the control tendons at 60DPI (P<0.05). The tissue engineered implants also reduced peritendinous adhesion, muscle fibrosis and atrophy, and increased ultrasonographical echogenicity and homogenicity, maturation and differentiation of the collagen fibrils and fibers, tissue alignment and volume of the regenerated tissue compared to those of the control lesions (P<0.05). The implants were gradually absorbed and substituted by the new tendon. Implantation of the bioimplants had a significant role in initiating tendon healing and the implants were biocompatible, biodegradable and safe for application in tendon reconstructive surgery. The results of the present study may be valuable in clinical practice.

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In vitro characterization of a novel tissue engineered based hybridized nano and micro structured collagen implant and its in vivo role on tenoinduction, tenoconduction, tenogenesis and tenointegration

Oryan

Moshiri

Meimandi-Parizi

2013

J Mater Sci: Mater Med

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Surgical reconstruction of large tendon defects is technically demanding. Tissue engineering is a new option. We produced a novel tissue engineered, collagen based, bioimplant and in vitro characterizations of the implant were investigated. In addition, we investigated role of the collagen implant on the healing of a large tendon defect model in rabbits. A two cm length of the left rabbit's Achilles tendon was transected and discarded. The injured tendons of all the rabbits were repaired by Kessler pattern to create and maintain a 2 cm tendon gap. The collagen implant was inserted in the tendon defect of the treatment group (n = 30). The defect area was left intact in the control group (n = 30). The animals were euthanized at 60 days post injury (DPI) and the macro- micro- and nano- morphologies and the biomechanical characteristics of the tendon samples were studied. Differences of P < 0.05 were considered significant. The host graft interaction was followed at various stages of tendon healing, using pilot animals. At 60 DPI, a significant increase in number, diameter and density of the collagen fibrils, number and maturity of tenoblasts and tenocytes, alignment of the collagen fibrils and maturity of the elastic fibers were seen in the treated tendons when compared to the control ones (P < 0.05). Compared to the control lesions, number of inflammatory cells, amount of peritendinous adhesions and muscle fibrosis and atrophy, were significantly lower in the treated lesions (P < 0.05). Treatment also significantly increased load to failure, tensile strength and elastic modulus of the samples as compared with the control ones. The collagen implant properly incorporated with the healing tissue and was replaced by the new tendinous structure which was superior both ultra-structurally and physically than the loose areolar connective tissue regenerated in the control lesions. The results of this study may be valuable in the clinical practice.

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Complex Achilles Reconstruction for Massive Soft Tissue Loss: Allograft, Autograft, and Use of a Temporary Cement Spacer

Abstract: A 36-year-old male sustained loss of the Achilles mechanism secondary to a crush injury. The patient was treated with early placement of a cement spacer in the superficial posterior compartment, which allowed for successful late reconstruction.

Cited by 14 publications

References 12 publications

Role of Embedded Pure Xenogenous Bovine Platelet Gel on Experimental Tendon Healing, Modelling and Remodelling

Role of Embedded Pure Xenogenous Bovine Platelet Gel on Experimental Tendon Healing, Modelling and Remodelling

Tendon Tissue Engineering and Its Role on Healing of the Experimentally Induced Large Tendon Defect Model in Rabbits: A Comprehensive In Vivo Study

In vitro characterization of a novel tissue engineered based hybridized nano and micro structured collagen implant and its in vivo role on tenoinduction, tenoconduction, tenogenesis and tenointegration

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