The Utility of Composite Flexor Tendon Allografts for Hand and Upper Extremity Reconstruction
Anthony J Archual, MD1; Brent R DeGeorge, MD, PhD1; David B. Drake, MD2; (1)University of Virginia, Charlottesville, VA, (2)Plastic Surgery Department, University of Virginia, Charlottesville, VA
Purpose: Composite flexor tendon allografts (CFTA) consisting of the intrasynovial digital flexor tendons and associated intact pulleys, volar plates, and periosteum harvested as single functional units with a distal bony attachment and processed with gamma irradiation techniques serve as a sterile, ready-to-use construct which can address fundamental problems in hand surgery. Specifically, they can provide a source of intrasynovial flexor tendon with its intact fibro-osseous sheath to perform single stage flexor tendon reconstruction. This construct can be further sub-divided into its component structures to address specific reconstructive needs in hand surgery.
Methods: We have established an IRB-approved protocol for using CFTA constructs for upper extremity reconstruction. We have performed an extensive biomechanical characterization of these CFTA constructs with respect to ultimate tensile strength and elastic modulus of the FDP and FDS tendon as well as differential gliding resistance, or fiber density of the CTA constructs before and after tissue processing. At present, we have utilized this CFTA construct to reconstruct devastating injuries to the palmar hand, extensor tendonopathies, thumb basal joint arthritis, and pulley reconstruction.
Results: The CFTA constructs show no significant difference in ultimate tensile strength, elastic modulus, or differential gliding resistance following tissue processing. We have studied 15 CFTA constructs in 8 patients with a follow-up period between 8 and 24 months. There have been no reported cases of surgical site infection, infectious disease transmission, tissue antigenicity, tendon rupture, or explantation of CFTA tissue. Patient reported functional outcomes as assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) score have improved from a baseline of 39.3 +/- 10.3 to 3.8 +/- 2.7 at six months postoperatively.
Conclusions: Herein, we describe a novel combination of tissue processing and operative techniques to directly address two fundamental problems in reconstructive surgery of the hand: scar formation and lack of suitable donor material. The CFTA construct can be applied in a safe and effective manner to reconstruct common problems outside of the digital flexor mechanism. These composite allografts provide a limitless source of intrasynovial tendon, pulley, volar plate, and bone with minimal tissue reactivity and negligible potential for disease transmission.
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