Regenerative medicine for soft-tissue coverage of the hand and upper extremity

Abstract

Soft-tissue deficits of the hand and upper extremity are commonly encountered by the hand surgeon, and the incorporation of regenerative medicine techniques within the reconstruction ladder of such deficits is becoming more accepted. Dermal regenerative templates and acellular dermal matrices, initially employed in burn reconstruction, have since found a niche in many other cases of soft-tissue loss, including complex defects having exposed vital structures (i.e. bone, tendon, nerve, and/or muscle). Understanding of when to choose regenerative medicine options for reconstruction can spare the morbidity of more complex procedures, offer surgical efficiencies, are reliable when appropriately employed, and can replace more advanced reconstructive ladder elements (e.g. flap based reconstructions) with better options in certain extremity reconstruction cases. These regenerative medicine tools have similarly been used to convert devitalized wound beds into beds with healthy granulation tissue receptive of skin grafting. Other regenerative techniques, e.g. fat grafting containing adipose derived stem cells, have also been utilized in hand surgery as volumizing agents and treatments for contracture and sclerosis. The growing body of literature surrounding dermal regenerative templates, acellular dermal matrices, urinary bladder matrix, and fat grafting in soft-tissue coverage of the hand is herein reviewed with illustrative cases depicted.

Acute Management of Thermal Hand Burns in Adults

“…A review of the role of regenerative medicine 140 focused on dermal regenerative templates (eg, Integra bilayer wound matrix; Integra Life Sciences, Plainsboro, New Jersey), acellular dermal matrices (eg, Matriderm; Medskin Solutions, Dr, Suwelack AG, Billerbeck, Germany), and nondermal regenerative matrices (eg, urinary bladder matrices), mentioning fat transfers as a later option. Elastin-based skin substitutes may positively affect functional outcomes, wound healing, wound contraction, and aesthetic scar outcome 141 …”

“…A comparison of the inflammatory processes and Doppler ultrasound findings in the regenerating fingertip laceration was compared with burn wounds, in terms of the mediators within the exudate, and blood flow, outlining the processes behind tissue regeneration and the differences between these injuries. 139 Dermal Substitutes: Acellular, Cellular, and Nonbiological A review of the role of regenerative medicine 140 focused on dermal regenerative templates (eg, Integra bilayer wound matrix; Integra Life Sciences, Plainsboro, New Jersey), acellular dermal matrices (eg, Matriderm; Medskin Solutions, Dr, Suwelack AG, Billerbeck, Germany), and nondermal regenerative matrices (eg, urinary bladder matrices), mentioning fat transfers as a later option. Elastin-based skin substitutes may positively affect functional outcomes, wound healing, wound contraction, and aesthetic scar outcome.…”

Novel Use of a Porcine Bladder Extracellular Matrix Scaffold to Treat Postoperative Seroma in a Total Knee Arthroplasty Patient

“…In patients with a postoperative seroma or large wound bed that requires a substantial amount of granulation tissue for "dead space" obliteration, UBMs provide a scaffolding to optimize organized tissue proliferation and potentially prevent further postoperative complications such as infection or dehiscence. In orthopedics, UBM use remains limited, and no cases have described the use of micronized UBM to treat recurrent seroma [33][34][35].…”