Can an adipofascial flap be used to prevent adhesions after plating of the proximal phalanx? A case report

Lucchina, Stefano; Maggiulli, Francesca; Tos, Pierluigi; Ionac, Mihai; Fusetti, Cesare

doi:10.1016/j.main.2014.12.005

Cited by 6 publications

(6 citation statements)

References 27 publications

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“…For harvesting of the AFF, we followed the surgical technique described in the original article. 7 Briefly, a rectangular-shaped 1.5 cm x 5.0 cm radially or ulnarly based skin incision was effectuated on the dorsal side of the proximal phalanx (Figure 1a). A rectangular subdermal 1.5 cm wide by 4.0 cm long AFF from the ipsilateral or opposite side, including a dorsal perforator branch of the palmar artery was harvested superficial to the extensor paratenon (Figures 1b and 2).…”

Section: Patient Recruitment and Datamentioning

confidence: 99%

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The Use of an Adipofascial Flap to Prevent Extensor Tendon Adhesions After Plating of the Proximal Phalanx of the Fingers: A Comparative Study

Lucchina

D’Ambrosio

Fusetti

et al. 2020

Hand (New York, N,Y.)

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Background: Extensor tendon adhesions occurring after proximal phalangeal (P1) fractures are not uncommon. A previous report described the use of an adipofascial flap (AFF) to prevent adhesions after dorsal plating of the P1. The purpose of the study is to examine the results of open reduction and internal fixation with the use of an AFF (F group) and without (N group, that is, no flap used) in a larger group of patients. Methods: A retrospective study involving a period of 11 years was conducted involving results of 21 unstable fractures of the P1 of the fingers in 18 patients. In all, 12 fingers were treated without any flap (N group) and 9 fingers were treated with the AFF (F group). For each patient, the total active motion (TAM) ratio, and the grip strength (Jamar) ratio were assessed, and adverse effects and the 10-point visual analogue scale (VAS) score were recorded. For statistical analysis, sample characteristics were described using mean ± standard deviation and median, and a Bayesian approach was used for inferential analysis. Results: In the F group, the TAM ratio (84% ± 13% vs 65% ± 17%) was higher with a lower rate of adverse effects (OR: 0.067, 95% CI, 0.0035-0.58,) and a lower VAS score with evidence of the positive effect of the AFF. The Jamar ratio was similar in the 2 groups (F group 80% ± 25% vs N group 79% ± 19%) with no associated effect of the AFF on grip strength. Conclusions: The AFF is a reliable tool to reduce adhesions between plates and the extensor apparatus of the P1 and may be useful to improve finger function after plating of P1 fractures. Type of study/LOE: Therapeutic, Retrospective, Level IV

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Section: Patient Recruitment and Datamentioning

confidence: 99%

“…Limited range of motion is a frequent complication after plate fixation and may lead to unsatisfactory results. 3,5,6 A previous report 7 on an isolated case of proximal phalangeal fracture described the utilization of a local adipofascial flap (AFF) as a technique to prevent adhesions after dorsal plating of the proximal phalanx.…”

Section: Introductionmentioning

confidence: 99%

The Use of an Adipofascial Flap to Prevent Extensor Tendon Adhesions After Plating of the Proximal Phalanx of the Fingers: A Comparative Study

Lucchina

D’Ambrosio

Fusetti

et al. 2020

Hand (New York, N,Y.)

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“…Mechanical barriers have been investigated as a means of producing a pseudosheath, thereby physically preventing tendon adhesion formation. Examples of such methods include nylon, silicon sheets, polyethylene membranes, as well as natural and polymeric membranes, and more recently, an adipo‐fascial flap . However, issues such as tendon necrosis, inflammation and fibrotic adhesion formation at the periphery of the barriers, were frequently encountered .…”

Section: Introductionmentioning

confidence: 99%

“…Examples of such methods include nylon, silicon sheets, polyethylene membranes, as well as natural and polymeric membranes, and more recently, an adipo-fascial flap. [7][8][9][10][11][12][13] However, issues such as tendon necrosis, inflammation and fibrotic adhesion formation at the periphery of the barriers, were frequently encountered. 14 The use of biological agents to prevent fibrosis have also been investigated.…”

Section: Introductionmentioning

confidence: 99%

Influence of steel implant surface microtopography on soft and hard tissue integration

et al. 2017

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After implantation of an internal fracture fixation device, blood contacts the surface, followed by protein adsorption, resulting in either soft-tissue adhesion or matrix adhesion and mineralization. Without protein adsorption and cell adhesion under the presence of micro-motion, fibrous capsule formation can occur, often surrounding a liquid filled void at the implant-tissue interface. Clinically, fibrous capsule formation is more prevalent with electropolished stainless steel (EPSS) plates than with current commercially pure titanium (cpTi) plates. We hypothesize that this is due to lack of micro-discontinuities on the standard EPSS plates. To test our hypothesis, four EPSS experimental surfaces with varying microtopographies were produced and characterized for morphology using the scanning electron microscope, quantitative roughness analysis using laser profilometry and chemical analysis using X-ray photoelectron spectroscopy. Clinically used EPSS (smooth) and cpTi (microrough) were included as controls. Six plates of each type were randomly implanted, one on both the left and right intact tibia of 18 white New Zealand rabbits for 12 weeks, to allow for a surface interface study. The results demonstrate that the micro-discontinuities on the upper surface of internal steel fixation plates reduced the presence of liquid filled voids within soft-tissue capsules. The micro-discontinuities on the plate under-surface increased bony integration without the presence of fibrous tissue interface. These results support the hypothesis that the fibrous capsule and the liquid filled void formation occurs mainly due to lack of micro-discontinuities on the polished smooth steel plates and that bony integration is increased to surfaces with higher amounts of micro-discontinuities. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 705-715, 2018.

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“…On the contrary, the key issue is represented by the presence or absence of vascularized gliding tissue that works as a barrier preventing tendon adhesions in the interface of the tendon plate. A case report 5 on an isolated unstable closed multifragmentary proximal phalangeal fracture described the utilization of a local adipofascial flap (AFF) as a useful tool to prevent tendon adhesions and leading to a good final ROM. There was reduced stiffness of the involved digit and no fixed flexion contracture of the proximal interphalangeal joint.…”

mentioning

confidence: 99%

Comments on “Complications of Low-Profile Plate Fixation of Phalanx Fractures”

Lucchina

Meroni

Molitor

et al. 2021

Hand (New York, N,Y.)

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Can an adipofascial flap be used to prevent adhesions after plating of the proximal phalanx? A case report

Cited by 6 publications

References 27 publications

The Use of an Adipofascial Flap to Prevent Extensor Tendon Adhesions After Plating of the Proximal Phalanx of the Fingers: A Comparative Study

The Use of an Adipofascial Flap to Prevent Extensor Tendon Adhesions After Plating of the Proximal Phalanx of the Fingers: A Comparative Study

Influence of steel implant surface microtopography on soft and hard tissue integration

Comments on “Complications of Low-Profile Plate Fixation of Phalanx Fractures”

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