The use of an acellular dermal regenerative tissue matrix in the treatment of lower extremity wounds: a prospective 16-week pilot study.

A prospective, single-centre, randomized controlled study was performed to evaluate the effectiveness of Graftjacket, a human acellular regenerative tissue matrix as a treatment option for chronic non healing lower extremity wounds. Twenty-eight diabetic patients with full-thickness wounds that had been present for at least 6 weeks were treated with sharp debridement and randomized to a single application of Graftjacket tissue matrix plus mineral oil-soaked fluff compression dressing or to a control treatment of wound gel with gauze dressings. All patients were seen weekly. By week 16, 12 of 14 patients treated with Graftjacket tissue matrix demonstrated complete wound closure compared with 4 of 14 patients in the control group. Patients treated with Graftjacket tissue matrix showed a statistically significant higher percentage of wound healing with respect to wound area, and clinically significant differences in wound depth and wound volume. This comparison is not performed to demonstrate that the application of the Grafjacket is more effective than sharp debridement. This study is done to help assign a role to the use of Graftjacket matrix in lower extremity wound care

The Use of Decellularized Human Placenta in Full-Thickness Wound Repair and Periarticular Soft Tissue Reconstruction: An Update on Regenerative Healing.

Prolonged or incomplete healing of the foot and ankle can pose significant challenges. Therefore, investigators have begun searching for alternative treatment strategies. With advances in tissue engineering, decellularized human placental connective tissue matrix has been suggested as a means to achieve more rapid and complete healing for various soft tissue and bone procedures. Basic science and clinical studies have shown that decellularized human placental connective tissue matrix can support regenerative healing through cellular migration, accelerated tissue remodeling, and the establishment of functional tissue. Additional research is needed to fully explore and evaluate clinical applications within the foot and ankle

Complex Total Ankle Arthroplasty.

Total ankle arthroplasty is a viable surgical technique for the treatment of end-stage degenerative joint disease. With continued advancement in prosthetic design, refined surgical techniques, and improved outcomes, the indications for total ankle replacement have expanded to include cases of increasing complexity. With meticulous preoperative planning and exacting execution, many frontal plane deformities and cases of avascular necrosis can now be successfully addressed at the time of prosthesis implantation or in a staged procedure

Evaluating Component Migration: Comparing Two Generations of the INBONE(®) Total Ankle Replacement.

Although total ankle replacement (TAR) designs have radically evolved, the compressive forces at the ankle can cause aseptic loosening, talar subsidence, and implant failure. The purpose of the present report was to compare the implant migration associated with the INBONE(®) I, a TAR system with a stemmed talar component, and the newer generation INBONE(®) II, a TAR system without a stemmed talar component (Wright Medical Technology, Inc., Arlington, TN). Because core decompression could weaken the integrity of the talus, we hypothesized that the stemmed component would result in greater implant migration. A total of 35 consecutive patients (age 58.2 ± 12.1 years; 23 men) were included. Of these 35 patients, 20 (57.1%) had been treated with the INBONE(®) I and 15 (42.9%) with the INBONE(®) II. To assess implant migration, using anteroposterior radiographs, the distance from the apex of the tibial component to the most distal aspect of the talar stem or to the mid-saddle of the nonstemmed component was measured. The measurements were recorded from the immediate postoperative radiographs and the 12-month postoperative radiographs. Implant migration was quantified as the difference between the 12-month and the immediate postoperative measurements. Despite our hypothesis, no significant difference was found in implant migration between the INBONE(®) I (0.7 ± 1.2 mm) and INBONE(®) II (0.6 ± 1.3 mm, p = .981). However, previously published data have suggested that implant migration can continue for ≥2 years after surgery. Therefore, additional investigations with larger sample sizes and longer follow-up periods are needed to draw definitive conclusions

Special segment: soft tissue matrices--soft-tissue augmentation of the foot and ankle using an acellular regenerative tissue scaffold.

Surgical treatment of damaged soft-tissue structures in the young and physically active patient requires keen understanding of biomechanical forces that are placed on the repair during rehabilitation. Over the years, several materials have been evaluated to mechanically augment suture repair. Autograft tissues such as the gastrocnemius fascia, flexor hallicus longus, peroneus brevis, fascia lata, and plantaris have been implemented successfully. Concerns over donor site morbidity have limited the use of these autologous tissues. Allografts such as fascia lata and tendon have been used successfully but are plagued with practical issues such as inflammatory reaction and suture retention weakness. Acellular regenerative tissue scaffolds have gained in popularity in recent years because of the limited host inflammatory response, ease of use, and high tensile strength

I think I have a good idea: what do I do with it?

The orthopaedic device industry is an ever changing market, often guided by creative surgeons who have the common goal of creating a solution to a problem. While being a surgeon-inventor can be both a challenging and rewarding process, there are several steps that the individual must follow to create intellectual property. This article serves as a guide to the novice surgeon-inventor; intended to be used as an early stage reference for those interested in taking their solution to a problem to the device industry

Reconstruction of complex osteochondral lesions of the talus with cylindrical sponge allograft and particulate juvenile cartilage graft: provisional results with a short-term follow-up.

Osteochondral lesions of the talus can be a challenging injury to treat for even the most experienced foot and ankle surgeon. Although the advances in imaging have made the diagnosis of chondral lesions more accurate, surgeons are still struggling to find ways to reliably treat advanced lesions with subchondral bone damage. This article looks at the use of allograft bone and particulate juvenile cartilage in patients with advanced subchondral bone damage and osteochondral lesions of the talus

Recent Advances in Acellular Regenerative Tissue Scaffolds.

The management of chronic wounds is a considerable challenge for foot and ankle surgeons. The well-established tenets of adequate vascular supply, debridement with eradication of infection, and offloading must be employed in the management of all extremity wounds. Regenerative scaffolds are a viable means of reestablishing a favorable wound environment. The matrix facilitates cell migration, chemoattraction, angiogenesis, wound bed granulation, and expedited wound closure. Although studies have demonstrated success with acellular matrices, a multimodal approach should always be employed to improve healing success. Negative pressure wound therapy, compression, offloading, and antibiotics are advocated to improve outcomes. Acellular graft selection requires a multifactorial analysis, taking into consideration the specific patient and wound characteristics as well as the differences between acellular matrices. Patient age, comorbidities, activity level, and ability to comply with protocol as well as wound etiology, duration, depth, surface area, exudate, bacterial burden, location, vascular status, ischemic status, and presentation are all critical components. To effectively choose a matrix, the clinician must have a comprehensive understanding of the products available and the data validating their use. The mechanisms by which the acellular matrix accelerates wound healing and increases the likelihood of wound healing continue to be investigated. However, it is clear that these acellular biologic tissue scaffolds are incorporating into the host tissue, with resultant revascularization and cellular repopulation. Moving forward, additional investigations examining the effectiveness of acellular biologic tissue scaffolds to improve healing in complex, nondiabetic wounds are warranted