Adu Yaw, Harder Justin, Cox Cameron, Baum Gracie, Hernandez Evan J, MacKay Brendan J
Department of Orthopaedic Hand Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, United States.
Front Surg. 2024 Dec 16;11:1447515. doi: 10.3389/fsurg.2024.1447515. eCollection 2024.
Tendon repairs often result in adhesion formation which can cause persisting functional deficits. Close proximity of healing tissues increases friction during tendon excursion, often leading to tendon tethering postoperatively. Despite continued improvements in techniques for tendon repairs, there is currently no consensus on the most effective modality to reduce adhesion formation. The VersaWrap Tendon Protector is a bioresorbable hydrogel that is FDA-cleared for use in tendon repair by separating healing tendons from surrounding tissues and improving tendon gliding. We conducted a study to assess the efficacy of VersaWrap in improving clinical outcomes related to adhesions and tethering in tendon repairs involving the hand.
MATERIALS & METHODS: Age, sex, injury type, mechanism of injury, visual analogue scale (VAS) pain scores, active and passive range of motion (ROM), percent return to normal function, and patient-reported outcomes forms (QuickDASH) were collected at baseline and routine follow up visits. Functional outcomes were classified according to Strickland and Glogovac grading system.
90 patients were included, with an average age of 39.8 years and a 44% female gender. The most common mechanism of injury was sharp laceration, and the majority of repairs involved the extensor mechanism (58.8% extensor, 35.3% flexor, 5.8% both). At a mean follow-up of 4.6 months, the mean active and passive ROM was 88.8% and 94.3%, respectively. Mean percent return of function was 87.7%. Good or Excellent functional outcomes were achieved in 92.3% of patients - 70.5% Excellent, 21.8% Good, 6.4% Fair, 1.3% Poor. The average QuickDASH score was 30.7, and the average final VAS pain score was 1.3.
Tendon repairs and tenolysis procedures often result in reduced functionality due to impeded tendon gliding, and there is currently no consensus on optimal treatment to prevent tethering to surrounding tissues. The VersaWrap Tendon Protector creates a gelatinous layer between the tendon and surrounding soft tissue to improve gliding resistance, thereby limiting tendon sheath adhesions. Our data suggests that VersaWrap may be a useful adjunct in preventing tendon tethering adhesion post-repair.
肌腱修复常常会导致粘连形成，进而可能引起持续的功能缺陷。愈合组织靠得很近会增加肌腱活动时的摩擦力，常常导致术后肌腱粘连。尽管肌腱修复技术不断改进，但目前对于减少粘连形成的最有效方式尚无共识。VersaWrap肌腱保护器是一种可生物吸收的水凝胶，已获得美国食品药品监督管理局（FDA）批准用于肌腱修复，通过将愈合的肌腱与周围组织隔开并改善肌腱滑动来发挥作用。我们开展了一项研究，以评估VersaWrap在改善手部肌腱修复中与粘连和粘连相关的临床结局方面的疗效。
在基线和常规随访时收集年龄、性别、损伤类型、损伤机制、视觉模拟评分（VAS）疼痛评分、主动和被动活动范围（ROM）、功能恢复至正常的百分比以及患者报告结局表格（QuickDASH）。功能结局根据斯特里克兰德（Strickland）和格洛戈瓦茨（Glogovac）分级系统进行分类。
纳入90例患者，平均年龄39.8岁，女性占44%。最常见的损伤机制是锐器切割伤，大多数修复涉及伸肌机制（伸肌占58.8%，屈肌占35.3%，两者都有的占5.8%）。平均随访4.6个月时，平均主动和被动ROM分别为88.8%和94.3%。功能恢复的平均百分比为87.7%。92.3%的患者获得了良好或优秀的功能结局——优秀的占70.5%，良好的占21.8%，中等的占6.4%，差的占1.3%。平均QuickDASH评分为30.7，平均最终VAS疼痛评分为1.3。
肌腱修复和肌腱松解术常常因肌腱滑动受阻而导致功能降低，目前对于预防与周围组织粘连的最佳治疗方法尚无共识。VersaWrap肌腱保护器在肌腱与周围软组织之间形成一层凝胶状层，以改善滑动阻力，从而限制腱鞘粘连。我们的数据表明，VersaWrap可能是预防修复后肌腱粘连的一种有用辅助手段。
