March 01, 2015
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Hyaluronic acid scaffold may avoid need for pediatric hand skin grafting

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The use of hyaluronic acid scaffolds may help improve congenital syndactyly release in pediatric patients, according to findings from a study of 36 children with complete syndactyly who underwent release procedures.

Lorenzo Garagnani, MD, reported at a meeting that Hyalomatrix PA (Anika Therapeutics; Bedford, Mass., USA) hyaluronic acid (HA) scaffolds can be used in place of traditional skin grafting techniques that sometimes result in complications and poor cosmetic outcomes. Antonio Landi, MD, director of the department of hand surgery and microsurgery at Policlinico di Modena University in Modena, Italy developed this technique which he, Garagnani and Mario Lando, MD, now use routinely.

“This is a simple and very reproducible graftless technique that allows for a tension-fixed suture for skin closure,” Garagnani said.

This procedure reduces the operating time and a patient’s time under anesthesia by 20% to 25% compared with a traditional procedure and allows performing multiple web procedures during a single operation, he said.

HA scaffold vs. skin grafts

Between December 2008 and December 2011 Garagnani and colleagues carried out the release of 42 webs in 38 hands of 36 children with complete syndactyly using an advanced HA scaffold. The patients’ mean age at the time of treatment was 38 months and outcomes were reported at a mean of 28 months postoperatively.

Following the release, the investigators applied a soft dressing to all the patients, which was typically removed after 3 weeks, average.

The graftless technique covers the bare areas of a patient’s hand and can cover any size skin defect, Garagnani said.

Pigmentation results

Outcomes the investigators assessed were web creep, secondary deformities, scar quality, and patient and parental satisfaction. Garagnani said all patients showed good pliability and pigmentation at the site where the HA scaffold was applied.

One patient, however, developed an infection after the procedure that resulted in failure of the scaffold and therefore the patient was excluded from the study. Another patient had recurrence of syndactyly due to displacement of the scaffold.

A viable alternative

When Garagnani discussed the results, he said none of the patients studied developed a secondary deformity and they showed a minimal amount of web creep. In addition, there were no hypertrophic scars or keloids from the procedure in any patients.

The average operating time for the HA scaffold procedure is less than for a skin graft procedure in these cases, and the use of a scaffold was also less expensive, according to Garagnani.

He said the patients’ families were “satisfied and happy” with the results.

The results of the study have shown the use of an HA scaffold in syndactyly release surgery can be a viable alternative to skin grafting procedures, Garagnani said. – by Robert Linnehan

Disclosure: Garagnani reports no relevant financial disclosures.