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Evaluation of outcomes of a novel Hyaluronic Acid/Alginate Hydrogel in Hand and Microsurgical Procedures
Raysa Cabrejo, MD
1, Connor Arquette, MD
2, Max L Silverstein, MD
2, Mitchell Ng, MD
3, Isabel Robinson, MD
1, Bauback Safa, MD
1; Walter C. Lin, MD
1(1)The Buncke Clinic, San Francisco, CA, (2)Division of Plastic & Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, (3)Maimonides Medical Center, Brooklyn, NY
Introduction: The formation of postoperative adhesions is a common complication after hand and microsurgical procedures which limit tendon gliding, nerve tethering and functional limitations. In this study we present a novel hyaluronic acid/alginate hydrogel that provides a gliding surface which then bioresorbs to prevent soft tissue adhesions after complex procedures. The aim of this study is to characterize its use, quantify perioperative complications rates and compare the outcomes between surgeries not utilizing the hydrogel and those utilizing it.
Materials & Methods: Retrospective case control study was performed of complex hand/microsurgery cases with and without the application of hyaluronic acid/alginate hydrogel in sheet or gel form at a single institution. Outcomes of infection, revision, surgery, tendon rupture and nerve complications, and presence of adhesions during second look planned or unplanned revision procedures were evaluated. Statistical analysis will be performed to compare the two matched cohorts.
Results: The hydrogel was utilized during tendon (98%), nerve (60%), and vessel exposure (35%) procedures. The overall complication rate was 4.8% with no reported cases of vessel thrombosis, tendon laceration repair failure, fracture nonunion, or replantation or flap loss. The unplanned revision surgery rate was 3.6% and cellulitis rate was 1.2%. A total of 9 revision surgeries, total planned and unplanned, occurred and 67% had no scarring observed. In addition, there was no difference in complication rates between sheet and gel forms (p=0.76).
Conclusions: This study demonstrates successful and safe application of the hydrogel in a variety of soft tissue environments in complex hand surgeries. According to varying studies, isolated tendon repair re-operation rates are about 11%, compared to the re-operation rate of 3.6% with the hydrogel. Please note there is ongoing retrospective collection of data to find adequate matched controls to make accurate comparisons about the efficacy of the product in our patient population.
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