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

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.

Source: Current Orthopaedic Practice - February 21, 2018 Category: Orthopaedics Tags: SPECIAL FOCUS: Hand Surgery Rotation Source Type: research