Clinical Outcomes and Safety Profile of a Novel Hyaluronic Acid/Alginate Hydrogel in Hand and Microsurgical...

Soft tissue adhesions following hand and microsurgical procedures are frequent and debilitating complications, limiting tendon gliding, entrapping nerves, and impairing outcomes. A fully resorbable hyaluronic acid/alginate hydrogel, available in sheet and gel formulations, was introduced to mitigate adhesion formation. This study aimed to (1) assess hydrogel application across varied tissue environments, (2) evaluate perioperative complication rates, and (3) compare outcomes between the 2 forms.

A retrospective review of 83 complex hand and microsurgery cases at a single institution was conducted. Hydrogel was applied intraoperatively to tendon, nerve, vessel, and bone exposures. Primary outcomes included complications (infection, rupture, revision), and secondary outcomes were adhesions noted during second-look procedures. Complication rates were compared between gel and sheet forms using a χ² test.

Hydrogel was most commonly applied to tendon (98%), nerve (60%), and vessel (35%) exposures. The overall complication rate was 4.8%, with no cases of thrombosis, tendon repair failure, or nonunion. One (1.2%) patient developed cellulitis, treated with oral antibiotics. Nine revision procedures occurred (6 planned, 3 unplanned), none related to hydrogel use. No adhesions were observed in unplanned revisions, and 3 of 6 planned revisions showed adhesions. No significant difference in complication rates was found between gel and sheet applications (P = 0.76).

The hyaluronic acid/alginate hydrogel demonstrated low complication rates and versatile application across tissue types. These findings support its safety and potential as an effective adjunct in complex hand and microsurgical procedures.