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Flexor tendon repair with amniotic membrane
Saket Prakash1, Pulkit Kalra1, Anil Dhal2
1Department of Orthopaedics, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India.
Purpose:
Flexor tendon adhesion to tissues is one of the most frequent complications reported after flexor tendon repair. The human amniotic membrane (HAM) was used to wrap the tendon repair site to decrease fibrotic response and tendon adhesion.
Methods:
A total of 19 patients with flexor tendon injuries were subjected to surgical repair. The repair site was wrapped with human amniotic membrane (HAM) in nine cases. The remaining ten cases served as controls as no HAM wrap was used. The clinical outcome was assessed by pain, range of motion, and pinch strength. The healing of repair was evaluated with high-frequency ultrasound; the biologic response was assessed with two inflammatory mediators, i.e., interleukin-6 and TGF-beta-1.
Results:
HAM wrap cases recorded less pain, higher total active range of motion, and better tendon glide on ultrasonography at follow-up (6-18 months). The levels of serum inflammatory biologic markers decreased in majority of HAM cases whereas they increased in controls at two to six weeks post-operatively. No infection/immune rejection phenomenon was seen in HAM wrap cases.
Conclusions:
HAM wrap around the tendon repair site resulted in quicker function and qualitatively better tendon healing on ultrasound, with a decrease of the biologic response.
