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James Chang - One of the best experts on this subject based on the ideXlab platform.

  • proceed with caution mouse deep digit Flexor Tendon injury model
    Plastic and reconstructive surgery. Global open, 2021
    Co-Authors: Ashley L. Titan, James Chang, Deshka S. Foster, Evan J Fahy, Kellen Chen, Ross Bennettkennett, Reinhold H Dauskardt, Geoffrey C Gurtner, Paige M Fox, Michael T. Longaker
    Abstract:

    The purpose of this study was to determine the feasibility of using mouse models for translational study of Flexor Tendon repair and reconstruction. Methods Quantitative data detailing the gross anatomy, biomechanical characteristics, and microscopic structure of the deep digit Flexor Tendon (DDF) of the mouse hindpaw were obtained. Histological characterization of the DDF and the anatomy of the digit in the mouse hindpaw are detailed. Biomechanical testing determined the load-to-failure, stress, elastic modulus, and the site of Tendon failure. Results In gross anatomy, the origins and insertions of the mouse deep digit Flexor Tendon are similar to those of the human digit, surrounded by a synovial sheath that is only 1- to 2-cells thick. A neurovascular network runs on each side of the digit outside the synovial sheath, but does not clearly penetrate it. The thickness of the DDF is 0.14 ± 0.03 mm and the width is 0.3 ± 0.03 mm. The thickness of the DDF is less than that of 9-0 nylon needle. The mean failure force of the deep Flexor Tendon was 2.79 ± 0.53N. Conclusions The gross anatomy of the mouse hindpaw digit is similar to that of the human digit except for key differences seen in the synovial sheath and vascular supply. The dimensions of the mouse DDF make it challenging to create a clinically translatable repair model using currently available surgical techniques. Despite the similarities between the human and mouse anatomy, and the powerful basic science tools available in murine models, mice are an unreliable model for assessing Flexor Tendon injury and repair.

  • Flexor Tendon: Development, Healing, Adhesion Formation, and Contributing Growth Factors.
    Plastic and reconstructive surgery, 2019
    Co-Authors: Ashley L. Titan, James Chang, Deshka S. Foster, Michael T. Longaker
    Abstract:

    Management of Flexor Tendon injuries of the hand remains a major clinical problem. Even with intricate repair, adhesion formation remains a common complication. Significant progress has been made to better understand the mechanisms of healing and adhesion formation. However, there has been slow progress in the clinical prevention and reversal of Flexor Tendon adhesions. The goal of this article is to discuss recent literature relating to Tendon development, Tendon healing, and adhesion formation to identify areas in need of further research. Additional research is needed to understand and compare the molecular, cellular, and genetic mechanisms involved in Flexor Tendon morphogenesis, postoperative healing, and mechanical loading. Such knowledge is critical to determine how to improve repair outcomes and identify new therapeutic strategies to promote tissue regeneration and prevent adhesion formation.

  • Flexor Tendon sheath engineering using decellularized porcine pericardium
    Plastic and Reconstructive Surgery, 2016
    Co-Authors: Kai Megerle, Colin Y L Woon, Armin Kraus, Shyam S Raghavan, Hung Pham, James Chang
    Abstract:

    The Flexor Tendon sheath is an ideal target for tissue engineering because it is difficult to reconstruct by conventional surgical methods. The authors hypothesized that decellularized porcine pericardium can be used as a scaffold for engineering a biologically active Tendon sheath. The authors’ protocol removed cellular material from the pericardium and preserved the structural architecture in addition to the collagen and glycosaminoglycan content. The scaffold was successfully reseeded with human sheath synoviocytes and human adipose-derived stem cells. Cells were evaluated for 8 weeks after reseeding. The reseeded construct demonstrated continuous production of hyaluronic acid, the main component of synovial fluid. After being seeded on the membrane, adipose-derived stem cells demonstrated down-regulation of collagen I and III and up-regulation of hyaluronan synthase 2. The results indicate that decellularized porcine pericardium may be a potential scaffold for engineering a biologically active human Tendon sheath.

  • IFSSH Flexor Tendon Committee Report 2014: From the IFSSH Flexor Tendon Committee (Chairman: Jin Bo Tang)
    Journal of Hand Surgery: European Volume, 2014
    Co-Authors: Jin Bo Tang, Michael Sandow, Donald H Lalonde, James Chang, David Elliot, Esther Vögelin
    Abstract:

    Hand surgeons continue to search for the best surgical Flexor Tendon repair and treatment of the Tendon sheaths and pulleys, and they are attempting to establish postoperative regimens that fit diverse clinical needs. It is the purpose of this report to present the current views, methods, and suggestions of six senior hand surgeons from six different countries - all experienced in Tendon repair and reconstruction. Although certainly there is common ground, the report presents provocative views and approaches. The report reflects an update in the views of the committee. We hope that it is helpful to surgeons and therapists in treating Flexor Tendon injuries.

  • studies in Flexor Tendon reconstruction biomolecular modulation of Tendon repair and tissue engineering
    Journal of Hand Surgery (European Volume), 2012
    Co-Authors: James Chang
    Abstract:

    The Andrew J. Weiland Medal is presented each year by the American Society for Surgery of the Hand and the American Foundation for Surgery of the Hand for a body of work related to hand surgery research. This essay, awarded the Weiland Medal in 2011, focuses on the clinical need for Flexor Tendon reconstruction and on investigations into Flexor Tendon biology. Reconstruction of the upper extremity is limited by 2 major problems after injury or degeneration of the Flexor Tendons. First, adhesions formed after Flexor Tendon repair can cause decreased postoperative range of motion and hand function. Second, Tendon losses can result from trauma and degenerative diseases, necessitating additional Tendon graft material. Tendon adhesions are even more prevalent after Tendon grafting; therefore these 2 problems are interrelated and lead to considerable disability. The total costs in terms of disability and inability to return to work are enormous. In this essay, published work from the past 12 years in our basic science laboratory is summarized and presented with the common theme of using molecular techniques to understand the cellular process of Flexor Tendon wound healing and to create substances and materials to improve Tendon repair and regeneration. These are efforts to address 2 interrelated and clinically relevant problems that all hand surgeons face in their practice.

Donald H Lalonde - One of the best experts on this subject based on the ideXlab platform.

  • IFSSH Flexor Tendon Committee Report 2014: From the IFSSH Flexor Tendon Committee (Chairman: Jin Bo Tang)
    Journal of Hand Surgery: European Volume, 2014
    Co-Authors: Jin Bo Tang, Michael Sandow, Donald H Lalonde, James Chang, David Elliot, Esther Vögelin
    Abstract:

    Hand surgeons continue to search for the best surgical Flexor Tendon repair and treatment of the Tendon sheaths and pulleys, and they are attempting to establish postoperative regimens that fit diverse clinical needs. It is the purpose of this report to present the current views, methods, and suggestions of six senior hand surgeons from six different countries - all experienced in Tendon repair and reconstruction. Although certainly there is common ground, the report presents provocative views and approaches. The report reflects an update in the views of the committee. We hope that it is helpful to surgeons and therapists in treating Flexor Tendon injuries.

  • wide awake Flexor Tendon repair and early Tendon mobilization in zones 1 and 2
    Hand Clinics, 2013
    Co-Authors: Donald H Lalonde, Alison L Martin
    Abstract:

    The wide-awake approach to Flexor Tendon repair has decreased our rupture and tenolysis rates and permitted us to get consistently good results in cooperative patients. The wide-awake surgery allows the repair of gaps of the surgical repair site revealed with intraoperative active movement testing of the repair We are now doing midrange active movement after primary Tendon repair. After tenolysis, full-range active motion is possible even before skin closure. We no longer perform Flexor Tendon repair with the tourniquet, sedation, and muscle paralysis of general or block (Bier or axillary) anesthesia.

  • avoiding Flexor Tendon repair rupture with intraoperative total active movement examination
    Plastic and Reconstructive Surgery, 2010
    Co-Authors: Amanda Higgins, Donald H Lalonde, Michael Bell, Daniel Mckee, Jan Lalonde
    Abstract:

    Background: Wide-awake Flexor Tendon repair in tourniquet-free unsedated patients permits intraoperative Total Active Movement examination (iTAMe) of the freshly repaired Flexor Tendon. This technique has permitted the intraoperative observation of Tendon repair gapping induced by active movement when the core suture is tied too loosely. The gap can be repaired intraoperatively to decrease postoperative Tendon repair rupture rates. The authors record their rupture rate in the first 15 years of experience with iTAMe. Methods: This was a retrospective chart review of 102 consecutive patients with wide-awake Flexor Tendon repair (no tourniquet, no sedation, and pure locally injected lidocaine with epinephrine anesthesia) in which iTAMe was performed by two hand surgeons in two Canadian cities between 1998 and 2008. Intraoperative gapping and postoperative rupture were analyzed. Results: The authors observed intraoperative bunching and gap formation with active movement in Flexor Tendon repair testing (iTAMe) in seven patients. In all seven cases, they redid the repair and repeated iTAMe to confirm gapping was eliminated before closing the skin, and those seven patients did not rupture postoperatively. In 68 patients with known outcomes, four of 122 Tendons ruptured (Tendon rupture rate, 3.3 percent) in three of 68 patients (patient rupture rate, 4.4 percent). All three patients who ruptured had accidental jerk forced rupture. All those patients who did what we asked them did not rupture. Conclusions: Tendons can gap with active movement if the core suture is tied too loosely. Gapping can be recognized intraoperatively with iTAMe and repaired to decrease postoperative rupture.

  • wide awake Flexor Tendon repair
    Plastic and Reconstructive Surgery, 2009
    Co-Authors: Donald H Lalonde
    Abstract:

    The wide-awake approach to hand surgery is performed with no sedation and no tourniquet. Only locally injected tumescent lidocaine and epinephrine are used for anesthesia and hemostasis. The confirmation that epinephrine hemostasis in the finger is safe1–5 has permitted the use of this technique, which has now become widespread in Canada. With exceptions that include hand surgery in small children, major trauma patients, and on those who are mentally challenged, more than 95 percent of all of the hand surgery in our center is now being performed with the wide-awake approach. With the possible exception of Tendon transfers,6 none of our hand operations have benefitted more from the advent of the wide-awake approach than Flexor Tendon repair. This videoplus presentation focuses on important technical aspects of wide-awake Flexor Tendon repair. It includes details of a zone 1 Flexor Tendon repair in a 16-year-old, from the injection of the local anesthetic to the 1-year postoperative result (see Video,SupplementalDigitalContent1,http://links. lww.com/A657 ).

Jin Bo Tang - One of the best experts on this subject based on the ideXlab platform.

  • Flexor Tendon Injuries
    Clinics in Plastic Surgery, 2019
    Co-Authors: Jin Bo Tang
    Abstract:

    : The developments in Flexor Tendon repairs have remarkably changed the methods of surgical repair of the Flexor Tendons and treatment of the critical annular pulleys, as well as the postoperative active motion protocols. The article summarizes the current knowledge and clinical methods in treating Flexor Tendon injuries, the keys to achieving reliable clinical repairs, and recent evolution in repair techniques and rehabilitation.

  • strong digital Flexor Tendon repair extension flexion test and early active flexion experience in 300 Tendons
    Hand Clinics, 2017
    Co-Authors: Jin Bo Tang, Jun Qing, Ke Tong Gong, Xiang Zhou, Jing Chen
    Abstract:

    : Over the past 2 decades, repair and rehabilitation methods of primary repair of the digital Flexor Tendon have changed. In this article, we outline interim results from ongoing investigations in several units. Surgeons in these units now perform digital Flexor Tendon repairs according to a treatment protocol. Before adopting the protocol, they had no history of Tendon-related research; they had not used any of the repair and rehabilitation methods described in the protocol. The surgeons involved are junior or midlevel attending surgeons. At the end of this article, we outline current practice of digital Flexor Tendon repair in Asian countries.

  • Wide-Awake Primary Flexor Tendon Repair, Tenolysis, and Tendon Transfer.
    Clinics in Orthopedic Surgery, 2015
    Co-Authors: Jin Bo Tang
    Abstract:

    Tendon surgery is unique because it should ensure Tendon gliding after surgery. Tendon surgery now can be performed under local anesthesia without tourniquet, by injecting epinephrine mixed with lidocaine, to achieve vasoconstriction in the area of surgery. This method allows the Tendon to move actively during surgery to test Tendon function intraoperatively and to ensure the Tendon is properly repaired before leaving the operating table. I applied this method to primary Flexor Tendon repair in zone 1 or 2, tenolysis, and Tendon transfer, and found this approach makes Tendon surgery easier and more reliable. This article describes the method that I have used for Tendon surgery.

  • IFSSH Flexor Tendon Committee Report 2014: From the IFSSH Flexor Tendon Committee (Chairman: Jin Bo Tang)
    Journal of Hand Surgery: European Volume, 2014
    Co-Authors: Jin Bo Tang, Michael Sandow, Donald H Lalonde, James Chang, David Elliot, Esther Vögelin
    Abstract:

    Hand surgeons continue to search for the best surgical Flexor Tendon repair and treatment of the Tendon sheaths and pulleys, and they are attempting to establish postoperative regimens that fit diverse clinical needs. It is the purpose of this report to present the current views, methods, and suggestions of six senior hand surgeons from six different countries - all experienced in Tendon repair and reconstruction. Although certainly there is common ground, the report presents provocative views and approaches. The report reflects an update in the views of the committee. We hope that it is helpful to surgeons and therapists in treating Flexor Tendon injuries.

  • current practice of primary Flexor Tendon repair a global view
    Hand Clinics, 2013
    Co-Authors: Jin Bo Tang, Peter C Amadio, Martin I Boyer, R Savage, Chunfeng Zhao, Michael J Sandow, Steve K Lee, Scott W Wolfe
    Abstract:

    In this article, a group of international leaders in Tendon surgery of the hand provide details of their current methods of primary Flexor Tendon repair. They are from recognized hand centers around the world, from which major contributions to the development of methods for Flexor Tendon repair have come over the past 2 decades. Changes made since the early 1990s regarding surgical methods and postoperative care for the Flexor Tendon repair are also discussed. Current practice methods used in the leading hand centers are summarized, and key points in providing the best possible clinical outcomes are outlined.

Aaron Daluiski - One of the best experts on this subject based on the ideXlab platform.

  • volar plate position and Flexor Tendon rupture following distal radius fracture fixation
    Journal of Hand Surgery (European Volume), 2013
    Co-Authors: Alison Kitay, Morgan M Swanstrom, Joseph J Schreiber, Michelle G Carlson, Joseph Nguyen, Andrew J Weiland, Aaron Daluiski
    Abstract:

    Purpose To determine whether there were differences between plate position in patients who had postoperative Flexor Tendon ruptures following volar plate fixation of distal radius fractures and those who did not. Methods Three blinded reviewers measured the volar plate prominence and position on the lateral radiographs of 8 patients treated for Flexor Tendon ruptures and 17 matched control patients without ruptures following distal radius fracture fixation. We graded plate prominence using the Soong grading system, and we measured the distances between the plate and both the volar critical line and the volar rim of the distal radius. Results A higher Soong grade was associated with Flexor Tendon rupture. Patients with ruptures had plates that were more prominent volarly and more distal than matched controls without ruptures. Plate prominence projecting greater than 2.0 mm volar to the critical line had a sensitivity of 0.88, a specificity of 0.82, and positive and negative predictive values of 0.70 and 0.93, respectively, for Tendon ruptures. Plate position distal to 3.0 mm from the volar rim had a sensitivity of 0.88, a specificity of 0.94, and positive and negative predictive values of 0.88 and 0.94, respectively, for Tendon ruptures. Conclusions We identified plate positions associated with attritional Flexor Tendon rupture following distal radius fracture fixation with volar plates. To decrease rupture risk, we recommend considering elective hardware removal after union in symptomatic patients with plate prominence greater than 2.0 mm volar to the critical line or plate position within 3.0 mm of the volar rim. Type of study/level of evidence Therapeutic III.

  • the epidemiology of reoperation after Flexor Tendon repair
    Journal of Hand Surgery (European Volume), 2012
    Co-Authors: Aaron Daluiski, Alexia Hernandezsoria, Robert G Marx, Stephen Lyman
    Abstract:

    Purpose To describe the incidence of reoperation and the demographic factors that may be associated with reoperation after Flexor Tendon repair. Methods Using a New York statewide hospital administrative database covering an 8-year period, we examined unique patient discharges with an index procedure of Flexor Tendon repair for reoperation (re-repair or tenolysis). We compared the age, sex, race, and insurance type by reoperation status using standard univariate statistics and multivariate regression analysis. We performed trend analysis using the Cochran-Armitage trend test. Results From 1998 to 2005, there were 5,229 Flexor Tendon repairs with a frequency of reoperation of 6%; of these, 91% were in the first year after the primary procedure. Those who underwent reoperation were significantly older than those who did not undergo reoperation. Patients with workers' compensation were 63% more likely to undergo reoperation than those with other forms of insurance. Patients who had concomitant nerve repair during the index procedure were 26% less likely to undergo reoperation. The rate of reoperation did not change during the study period. Conclusions These results may be useful in shaping research agendas to evaluate sociodemographic factors contributing to reoperations. Type of study/level of evidence Prognostic II.

  • complications after Flexor Tendon repair a systematic review and meta analysis
    Journal of Hand Surgery (European Volume), 2012
    Co-Authors: Alexia Hernandezsoria, Timothy T Roberts, Aaron Daluiski
    Abstract:

    Purpose Although outcomes after Flexor Tendon repair have reportedly improved with modern treatment, complications are common. The purpose of this study was to determine the incidence of these complications and the potential contributory factors within the published literature. Methods We performed a systematic review of the available literature to identify publications in which patients with Flexor Tendon ruptures were surgically treated. We extracted demographics, zone of injury, core suture technique (only modified Kessler or a combination of techniques), use of epitendinous suture, and date of publication (before or after January 1, 2000). We excluded articles if they did not report information on reoperation, rupture, or adhesions. We used unadjusted pooled meta-analysis to report the incidence of complications, and meta-regression to describe the potential contributory factors for each complication while controlling for age, gender, and zone of injury. Results Unadjusted meta-analysis revealed rates of re-operation of 6%, rupture of 4%, and adhesions of 4%. Meta-regression analysis of 29 studies showed that core suture technique or use of an epitendinous suture does not influence rupture. However, the presence of an epitendinous suture decreases re-operation by 84%. Adhesion development is 57% lower when the modified Kessler technique is used. The incidence of complications did not vary with publication date. Conclusions The published literature supports use of the modified Kessler repair technique with an epitendinous suture to minimize complications. Although complication rates are low, our data suggest that there has been no definitive improvement in reported complications before and after 2000. Type of study/level of evidence Therapeutic III.

Peter C Amadio - One of the best experts on this subject based on the ideXlab platform.

  • biological analysis of Flexor Tendon repair failure stump tissue a potential recycling of tissue for Tendon regeneration
    Bone and Joint Research, 2019
    Co-Authors: Tao Zhang, Peter C Amadio, Ramona L Reisdorf, Steven L Moran, Anne Gingery, Chunfeng D Zhao
    Abstract:

    Objectives Re-rupture is common after primary Flexor Tendon repair. Characterization of the biological changes in the ruptured Tendon stumps would be helpful, not only to understand the biological ...

  • current practice of primary Flexor Tendon repair a global view
    Hand Clinics, 2013
    Co-Authors: Jin Bo Tang, Peter C Amadio, Martin I Boyer, R Savage, Chunfeng Zhao, Michael J Sandow, Steve K Lee, Scott W Wolfe
    Abstract:

    In this article, a group of international leaders in Tendon surgery of the hand provide details of their current methods of primary Flexor Tendon repair. They are from recognized hand centers around the world, from which major contributions to the development of methods for Flexor Tendon repair have come over the past 2 decades. Changes made since the early 1990s regarding surgical methods and postoperative care for the Flexor Tendon repair are also discussed. Current practice methods used in the leading hand centers are summarized, and key points in providing the best possible clinical outcomes are outlined.

  • the resurgence of barbed suture and connecting devices for use in Flexor Tendon tenorrhaphy
    Hand, 2011
    Co-Authors: Yazeed Mazen Gussous, Peter C Amadio, Chunfeng D Zhao, Kai Nan An
    Abstract:

    Barbed sutures and connecting devices have been historically described and used in Flexor Tendon tenorrhaphies. With the improvement in biomaterial, we have witnessed recently the resurgence of this concept. In this article, we review the historical use of barbed devices in repairing Flexor Tendons and explore the available barbed surgical devices that have been described in recent years.

  • factors that influence the outcome of zone i and zone ii Flexor Tendon repairs in children
    Journal of Hand Surgery (European Volume), 2006
    Co-Authors: Bassem T Elhassan, Steven L Moran, Cesar J Bravo, Peter C Amadio
    Abstract:

    Purpose To evaluate the factors that influenced the clinical results of zone I and II Flexor Tendon repairs in children at a single institution. Methods Forty-one fingers (35 patients) in patients ages 2 to 14 years with zone I or II Flexor Tendon injuries were identified. There was a zone I Tendon injury in 16 fingers and a zone II Tendon injury in 25 fingers. Concomitant injuries to the digital nerves were seen in 18 fingers. Primary repair was performed within 1 week in 35 fingers and delayed repair (2–9 wk) was performed in 6 fingers. After surgery 22 fingers (21 patients) were treated with early controlled mobilization and 19 fingers (14 patients) were treated with plaster immobilization. Results All patients were available for evaluation at a mean follow-up period of 42 months. Patients were subdivided into 2 age groups: (1) 0 to 7 years and (2) 8 to 15 years. Digital performance was evaluated by determining the percentage return of normal finger function according to a total active motion formula. Functional evaluation of all digits in both groups showed excellent or good results. Zone I repairs had better results than zone II repairs and isolated Tendon repairs had better results than those with associated nerve repairs. The age of the patients nor postoperative protocol did not influence the final digital motion. Conclusions A good outcome can be expected after repair of zone I or II Flexor Tendon injuries in children. Type of study/level of evidence Prognostic III.