PURPOSE: Skin graft is the gold standard surgical treatment in burn wound management. But it has functional and aesthetic limitations, such as burn scar contracture, low quality of the grafted skin, unnatural looking skin, loss of skin elasticity, especially in extensive deep burn wound which has tendon or bone exposed. The authors used Matriderm(R), a dermal analogue, with split-thickness skin graft simultaneously in burn wound and evaluate the effectiveness of Matriderm(R) for treatment of burn wounds, in comparison with the skin graft only. METHODS: 40 burn patients with skin graft were included in this study. Patients were selected with their consent for inclusion in an experimental group and a control group. Patients in the experimental group received a meshed Matriderm(R) appliance and a split-thickness skin graft, while those in the control group received only a split-thickness skin graft. Time to complete epithelization, rates of skin graft taken areas, Vancouver scar scale assessment, skin elasticity was evaluated. RESULTS: A better scores of Vancouver scar scale assessment (3 points) were observed in the experimental group with the control group (6 points) with statistical significance (P<0.05). A higher elasticity ratio of the affected side to the non-affected side was observed in the experimental group, compared with the control group (P<0.05), and a similar time to complete epithelization and rates of skin graft taken areas were observed in the experimental group when compared with the control group. CONCLUSION: Meshed Matriderm(R) enables effective healing and improves functional and aesthetic results in split thickness skin graft treatment of burn wounds.
Burns ; Cicatrix ; Contracture ; Elasticity ; Humans ; Skin ; Skin Transplantation ; Tendons ; Transplants

PURPOSE: The objective of this study was to evaluate clinical results of dual miniplate fixation for comminuted or periarticular fractures of the hand. MATERIALS AND METHODS: Twenty cases in 18 patients who had comminuted or periarticular fractures of metacarpal or phalangeal bones were treated with dual miniplate fixation from April, 2007 to May, 2009. The mean followed up period was 14.7 months. Our study included comminuted or periarticular fractures which were difficult to keep the fixation by pining or single plating. We evaluated radiologic bony union, angular or rotational deformity, extensor tendon irritaion and total arc of motion. RESULTS: Bony union was achieved successfully after primary dual miniplate fixationin in 12 cases. In 7 cases with a nonunion following previous operative fixation, bony union was obtained by dual miniplate fixation and bone grafting. In one case who had received primary dual plate fixation, nonunion occurred due to massive bone defect. Bony union was obtained by secondary dual plate fixation and bone grafting. Postoperative rotational deformity, angular deformity and irritation symptom were not observed in all cases. Functionally acceptable range of active motion was restored by way of early active motion. CONCLUSION: The dual miniplate fixation is one of the useful method for comminuted metacarpal or phalangeal fractures which cannot obtain firm fixation by other methods.
Bone Transplantation ; Congenital Abnormalities ; Fractures, Comminuted ; Hand ; Humans ; Tendons

OBJECTIVETo prepare a new xenogenic material using patented biochemical techniques for tissue disposal and investigate its possibility to be used as implant materials.

METHODSThe xenogenic implant materials were prepared by treatment of fresh porcine tendon with epoxy cross-linking fixation, antigen minimization procedures, mechanical enhancement by protein molecule modification and surface treatments. Histological and scanning electron microscopic observations were conducted, and physicochemical property assessment was carried out to determine the mechanical properties, protein contents, polyepoxy compound residual and stability of the material. The in vitro cytotoxicity of the material was tested in NCTC L929 cells, and the optical density of the cells at 24, 48, and 72 h of the treatments was determined to calculate the relative growth rate (RGR).

RESULTSHistological observation suggested that the xenogenic implant material consisted primarily of collagen without cell fragments. Scanning electron microscopy demonstrated homogeneous alignment of the collagen fibers in the material. The tensile strength of the material was 11-16 MPa, and the breaking elongation rate was 52%-67%; the protein contents was 94% with polyepoxy compound residual less than 5 microg/ml. The material maintained stable pH value in PBS. The L929 cells incubated with the biomaterials grew well with a relative growth rate over 89%.

CONCLUSIONThe new biomaterial has good physicochemical properties and good biocompatibility, and may served as a promising implant material.

Animals ; Biocompatible Materials ; Cell Line ; Implants, Experimental ; Materials Testing ; Mice ; Swine ; Tendons ; transplantation ; Transplantation, Heterologous

OBJECTIVETo analyze the histological results and the biological remodeling of ligamentous insertion after the reconstruction of anterior cruciate ligament (ACL) with autograft or allograft tendon.

METHODSExtensor digitorum tendon was harvested from hind limb as graft material and transplanted to reconstruct the resected ACL in 12 mongrel dogs. Each free tendon end was secured by holding sutures and then the sutures were tied to the post screw at the femoral and tibial bony tunnel outlet after transplantation respectively. Autograft was randomly performed on one side of knee while allograft on the other side of knee. After transplantation, the histological analysis was undertaken at the 6th, 12th weeks and the 6th month using hematoxylin-eosin (HE) stain under light microscope.

RESULTSThe insertion structure of normal ACL typically consisted of four layers, i.e., dense connective tissue, fibrocartilage, mineralized fibrocartilage and bone. There was a distinct regular tidemark line between fibrocartilage and mineralized fibrocartilage. At the 6th week postoperatively, loose connective tissue presented in the interspace between graft and bony tunnel wall in both autograft and allograft groups. At the 12th week postoperatively, the collagenous fibers between autograft and tunnel wall became well organized and the four layers of insertion with discontinuous tidemark line were demonstrated indistinctly in autograft group but not in allograft group. At the 6th month postoperatively, both of a clear and continuous tidemark line and distinct four layers could be seen in autograft group. In allograft group, only a waved discontinuous tidemark line was shown and either the anatomic morphology or the maturity of insertion was inferior to that of autograft group.

CONCLUSIONSAt the 6th month postoperatively, although the ligament-cartilage insertion is primarily formed after ACL reconstruction with autograft or allograft tendon, the histological morphology and the maturation of insertion of autograft tendon are better than those of allograft group, which suggests that postoperative rehabilitation should be paid more attention and could be safer if little delayed during ACL reconstruction with allograft tendon.

Animals ; Anterior Cruciate Ligament ; pathology ; surgery ; Dogs ; Reconstructive Surgical Procedures ; rehabilitation ; Tendons ; pathology ; transplantation ; Transplantation, Autologous ; Transplantation, Homologous

OBJECTIVETo compare the clinical outcomes of ACL reconstruction using allograft anterior tibialis and autologous hamstring tendon.

METHODSFrom September 2005 to May 2007, 100 ACLs were reconstructed, allograft were inplanted in 50 patients and autograft 50 patients. Rigidfix and Intrafix were used for graft fixation. The symptoms and objective signs were compared between two groups. Lysholm score were used for outcome evaluation.

RESULTSThere were neither infection nor rupture of the reconstructed ACLs in all patients. All patients were followed and the average follow-up period was 25.6 months (range 12 to 33). There was no positive pivot shift sign in two groups, the anterior drawer test (ADT)and Lachman test were negative or grade I positive. There was no difference in Lysholm scores between two groups(89.3 allograft vs. 90.5 autograft, P>0.05).

CONCLUSIONThese data suggest that there are no differences in clinical outcomes of ACL reconstruction with allograft anterior tibialis tendon and autologous hamstring tendon.

Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Reconstructive Surgical Procedures ; Tendons ; transplantation ; Tibia ; transplantation ; Transplantation, Autologous ; Transplantation, Homologous

OBJECTIVETo evaluate therapeutic effects for reconstruction of anterior cruciate ligament(ACL)with hamstring tendon autografts and bioabsorbable interference screws fixation under arthroscopy.

METHODSThirty-one patients with ACL rupture were verified through arthroscopy. There were 27 patients were male and 4 patients were female, ranging in age from 17 to 40 years,with an average of 25 years. Among the patients, 26 patients combined with meniscus injuries, 3 patients with injuries of articular cartilage and 16 patients with I to II degree degeneration of articular cartilage. All the patients were performed ACL reconstruction with hamstring tendon autografts under arthroscopy and the reconstructed ligaments were fixed with bioabsorbable interference screws.

RESULTSNo severe complications occurred at early stage after operation. Thirty patients were followed up and ranged from 9 to 39 months,with an average of (19 +/- 9.0) months. Lysholm score significantly increased from average of 54.6 +/- 16.6 preoperatively to average of 92.5 +/- 5.7 at the end of follow-up period (t = 11.84, P < 0.01). Twenty-six patients restored to normal activity.

CONCLUSIONACL reconstructed with hamstring tendon autografts under arthroscopy has advantages of minimal trauma and satisfactory outcomes.

Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; Arthroscopy ; Female ; Humans ; Male ; Reconstructive Surgical Procedures ; Tendons ; surgery ; transplantation ; Transplantation, Autologous ; Treatment Outcome

This investigation was to study the effects of cage-squeezing screw on tendon-bone healing in rabbits. The tendons of Twenty four rabbits were severed and fixed with cage-squeezing screw or ordinary squeezing screw on its tibia, and the interface of tendon-bone was tested at the ends of 3, 6 and 12 weeks after operations, respectively. The cage-squeezing screw can accelerate bone tunel healing and strengthen the graft intension. The experiments proved that the cage-squeezing screw could help the restructuring process of the graft after the beginning of reconstruction.
Animals ; Bone Screws ; Female ; Knee Joint ; surgery ; Male ; Periosteum ; transplantation ; Rabbits ; Tendons ; transplantation ; Tibia ; pathology ; surgery ; Wound Healing

OBJECTIVETo evaluate the effect of reconstruction of anterior cruciate ligaments (ACL) with allogeneic tendon or autologous hamstring tendon under arthroscopy.

METHODSThirty-two cases of ACL injury (3 cases compound with PCL injury) were reviewed. All the patients were divided into two groups randomly. Fifteen cases were reconstructed with hamstring tendon, including 12 male and 3 female with the age ranging from 23 to 61 years. Seventeen cases were reconstructed with allograft, including 11 male and 6 female with the age ranging from 17 to 57 years. The tendons were fixed with absorbable or Ti screws. All patients were recorded symptoms,physical signs and Lysholm Scores two weeks after operation,and functional rehabilitation of knee six months after operation.

RESULTSAll cases were followed up from 6 to 8 months. Pain and clinical symptoms disappeared and the function of knee joint was improved in all patients. Five patients of allograft with positive Lachman test result,one with severe graft rejection was found complete absorption of allograft under arthroscopy. No significant differences were seen in Lysholm Score between the two groups,average (88.5 +/- 7.2), (93.2 +/- 8.5) after operation (P > 0.05).

CONCLUSIONThe effects of reconstruction of cruciate ligaments with allogeneic tendon or autologous hamstring tendon under arthroscopy are more satisfying. But there are more symptoms and obvious individual differences in the earlier stage of rehabilitation. So reconstruction of cruciate ligaments under arthroscopy using autologous hamstring tendon should be performed as far as possible.

Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; Arthroscopy ; Female ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Tendons ; transplantation ; Transplantation, Homologous

Wounds with exposed tendon or bone and chronic wounds present a difficult treatment challenge. Vacuum- assisted closure technique and device has become a widely accepted technique in the management of difficult and chronic wounds. But, the cost is still relatively high and the treatment is not fully covered by insurance. We designed the simple modality of continuous negative therapy using wall suction for the wound treatment. The sterile foam filled the entire wound and the tube was placed in the foam. The site was covered with an adhesive sheet. The tube was then connected to the wall suction, and negative pressure(125 mmHg) was applied to the wound site. Wounds were inspected and the dressings were changed every other day. This continuous negative pressure therapy using wall suction reduced the amount of tissue edema and increased localized blood flow, and the applied forces resulted in enhanced formation of granulation tissue. The wounds could be closed primarily or covered with split thickness skin grafting. We conclude that this continuous negative pressure therapy using a wall suction is an efficient modality for treating difficult and chronic wounds with a moderate cost.
Adhesives ; Bandages ; Edema ; Granulation Tissue ; Insurance ; Negative-Pressure Wound Therapy ; Skin Transplantation ; Suction ; Tendons ; Wounds and Injuries*

Wounds with exposed tendon or bone and chronic wounds present a difficult treatment challenge. Vacuum- assisted closure technique and device has become a widely accepted technique in the management of difficult and chronic wounds. But, the cost is still relatively high and the treatment is not fully covered by insurance. We designed the simple modality of continuous negative therapy using wall suction for the wound treatment. The sterile foam filled the entire wound and the tube was placed in the foam. The site was covered with an adhesive sheet. The tube was then connected to the wall suction, and negative pressure(125 mmHg) was applied to the wound site. Wounds were inspected and the dressings were changed every other day. This continuous negative pressure therapy using wall suction reduced the amount of tissue edema and increased localized blood flow, and the applied forces resulted in enhanced formation of granulation tissue. The wounds could be closed primarily or covered with split thickness skin grafting. We conclude that this continuous negative pressure therapy using a wall suction is an efficient modality for treating difficult and chronic wounds with a moderate cost.
Adhesives ; Bandages ; Edema ; Granulation Tissue ; Insurance ; Negative-Pressure Wound Therapy ; Skin Transplantation ; Suction ; Tendons ; Wounds and Injuries*