Novel use of a flowable collagen-glycosaminoglycan matrix (Integra™ Flowable Wound Matrix) combined with percutaneous cannula scar tissue release in treatment of post-burn malfunction of the hand--A preliminary 6 month follow-up

C Hirche; A Senghaas; S Fischer; S T Hollenbeck; T Kremer; U Kneser

doi:10.1016/j.burns.2015.10.013

Novel use of a flowable collagen-glycosaminoglycan matrix (Integra™ Flowable Wound Matrix) combined with percutaneous cannula scar tissue release in treatment of post-burn malfunction of the hand--A preliminary 6 month follow-up

Burns. 2016 Feb;42(1):e1-e7. doi: 10.1016/j.burns.2015.10.013. Epub 2015 Dec 2.

Authors

C Hirche¹, A Senghaas², S Fischer², S T Hollenbeck³, T Kremer², U Kneser²

Affiliations

¹ Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG-Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany. Electronic address: Christoph.hirche@bgu-ludwigshafen.de.
² Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG-Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany.
³ Division of Plastic and Reconstructive Surgery, Duke University Medical Center, DUMC 3945, Durham, NC 27710, USA.

PMID: 26652220
DOI: 10.1016/j.burns.2015.10.013

Abstract

Introduction: Long-term function following severe burns to the hand may be poor secondary to scar adhesions to the underlying tendons, webspaces, and joints. In this pilot study, we report the feasibility of applying a pasty dermal matrix combined with percutaneous cannula teno- and adhesiolysis.

Patients and methods: In this 6 month follow-up pilot study, we included eight hands in five patients with hand burns undergoing minimal-invasive, percutaneous cannula adhesiolysis and injection of INTEGRA™ Flowable Wound Matrix for a pilot study of this new concept. The flowable collagen-glycosaminoglycan wound matrix (FCGWM) was applied with a buttoned 2mm cannula to induce formation of a neo-gliding plane. Post treatment follow-up was performed to assess active range of motion (AROM), grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, Vancouver Scar Scale (VSS) and quality of life Short-Form (SF)-36 questionnaire.

Results: No complications were detected associated with the treatment of FCGWM injection. The mean improvement (AROM) at 6 months was 30.6° for digits 2-5. The improvement in the DASH score was a mean of 9 points out of 100. The VSS improved by a mean of 2 points out of 14.

Discussion: The study demonstrates the feasibility and safety of percutaneous FCGWM for dermal augmentation after burn. Results from this pilot study show improvements in AROM for digits 2-5, functional scores from the patient's perspective (DASH) and scar quality (VSS). The flowable form of established INTEGRA™ wound matrix offers the advantage of minimal-invasive injection after scar release in the post-burned hand with a reduction in the risk of postsurgical re-scarring.

Keywords: Adhesiolysis; Dermal augmentation; Hand burns, scar; Integra; Minimal-invasive; Scar release; Wound matrix, flowable collagen–glycosaminoglycan wound matrix.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Burns / complications
Burns / surgery*
Catheterization
Catheters
Chondroitin Sulfates / therapeutic use*
Cicatrix / etiology
Cicatrix / physiopathology
Cicatrix / surgery*
Collagen / therapeutic use*
Feasibility Studies
Female
Hand Injuries / complications
Hand Injuries / surgery*
Hand Joints / physiopathology*
Hand Strength*
Humans
Male
Middle Aged
Minimally Invasive Surgical Procedures
Pilot Projects
Plastic Surgery Procedures
Range of Motion, Articular*
Tissue Adhesions / etiology
Tissue Adhesions / physiopathology
Tissue Adhesions / surgery*
Treatment Outcome

Substances

integra artificial skin
Chondroitin Sulfates
Collagen