Reanimation of Thumb Extension after Upper Extremity Degloving Injury Treated with Integra®

Katrana, F.; Kostopoulos, Epameinondas; Goletti, Delia; Lunel, G. Goudet; Casoli, Vincent

doi:10.1177/1753193408096021

Cited by 14 publications

(7 citation statements)

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“…Integra® was applied directly on flexor tendons without paratenon and the median nerve, with a reported excellent outcome. Katrana et al (2008) reported a satisfying aesthetic and functional final result in a severe case of a severe third-degree burn to the left hand in a 45-year-old man resulting in a degloving injury with complete destruction of the extensor apparatus of the thumb and exposure of the proximal interphalangeal joint. They successfully restore extension and flexion (ROM: MP 0–45° and IP 0–30°) combining the use of Integra® with a tendon graft provided by the extensor indicis.…”

Section: Discussionmentioning

confidence: 99%

Management of severe hand wounds with integra® dermal regeneration template

Weigert¹,

Choughri²,

Casoli³

2010

J Hand Surg Eur Vol

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We report our experience with the use of Integra® for the management of severe traumatic wounds of the hand. Fifteen patients were treated with follow-up ranging from 10 to 37 months. Wounds were associated with an osseous and/or joint and/or tendon exposure. Following Integra® placement, patients were managed with dressings and subsequent split-thickness skin grafting an average of 26 days later. Integra® was successful in achieving durable, functional and aesthetic definitive coverage in 13 of 15 applications while allowing a satisfying pollicidigital prehension. Regarding our clinical experience, Integra® is an effective technique to deal with severe wounds of the hand with exposed tendon and/or bone and/or joint, even in the absence of paratenon or periosteum. This can potentially lessen the need for local rotational or free flap coverage and should be taken into consideration as a viable alternative in traumatic reconstruction of the hand.

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Section: Discussionmentioning

confidence: 99%

Management of severe hand wounds with integra® dermal regeneration template

Weigert¹,

Choughri²,

Casoli³

2010

J Hand Surg Eur Vol

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“…Clinical use of these devices, especially the first, appears to be steadily increasing in clinics around the world (e.g. Katrana et al 2008;Sasidaran et al 2008;Wakabayashi et al 2008;Baldwin et al 2009). …”

Section: (C) Established Clinical Usesmentioning

confidence: 99%

Biologically active collagen-based scaffolds: advances in processing and characterization

Yannas

Tzeranis

Harley

et al. 2010

Phil. Trans. R. Soc. A.

124

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A small number of type I collagen-glycosaminoglycan scaffolds (collagen-GAG scaffolds; CGSs) have unusual biological activity consisting primarily in inducing partial regeneration of organs in the adult mammal. Two of these are currently in use in a variety of clinical settings. CGSs appear to induce regeneration by blocking the adult healing response, following trauma, consisting of wound contraction and scar formation. Several structural determinants of biological activity have been identified, including ligands for binding of fibroblasts to the collagen surface, the mean pore size (which affects ligand density) and the degradation rate (which affects the duration of the wound contraction-blocking activity by the scaffold). Processing variables that affect these determinants include the kinetics of swelling of collagen fibres in acetic acid, freezing of the collagen-GAG suspension and cross-linking of the freeze-dried scaffold. Recent developments in the processing of CGSs include fabrication of scaffolds that are paucidisperse in pore size, scaffolds with gradients in physicochemical properties (and therefore biological activity) and scaffolds that incorporate a mineral component. Advances in the characterization of the pore structure of CGSs have been made using confocal and nonlinear optical microscopy (NLOM). The mechanical behaviour of CGSs, as well as the resistance to degradative enzymes, have been studied. Following seeding with cells (typically fibroblasts), contractile forces in the range 26-450 nN per cell are generated by the cells, leading to buckling of scaffold struts. Ongoing studies of cell-seeded CGSs with NLOM have shown an advantage over the use of confocal microscopy due to the ability of the former method to image the CGS surfaces without staining (which alters its surface ligands), reduced cell photodamage, reduced fluorophore photobleaching and the ability to image deeper inside the scaffold.

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“…It is designed to act as a skin regeneration scaffold that allows the host's cells to grow into the dermal template. Although it was initially approved by the Food and Drug Administration to treat burn injuries [4], its indications continue to expand due to numerous accounts of desirable clinical and histologic outcomes [2–5, 7, 11–13, 17, 19, 20]. Currently, its use spans multiple areas of reconstructive surgery, including soft tissue coverage following tumor excision [2–5, 7, 11–13, 17], soft tissue coverage following the repair of congenital defects [11], and traumatic loss of soft tissue [3, 12, 19, 20].…”

Section: Introductionmentioning

confidence: 99%