gms | German Medical Science

Objectives/Interrogation: Perineural and peritendineous scar formation is responsible for loss of function, pain, loss of gliding in peripheral nerve and tendon surgery. Collagen synthesis rate is considerably increased during the 4th week. Dynavisc® is a carboxymethylcellulose (CMC) and Polyethylene Oxide (PEO) gel based on a novel surgical device designed to reduce postsurgical adhesions, creating a physical barrier combined with the immunomodulation of the inflammatory fase. Wide awake (WALANT) is a new-technique in hand surgery anesthesia without the use of turquet and the active movement and collaboration of the patient during the surgery. Therir efficacy, when they are used in the same time, was assessed in a retrospective, randomized, controlled, clinical trial, comparing results of thenorrhaphy of flexor tenolysis in zone 2.

Methods: In control group of 12 consecutive flexor tendons repair a standard tenorrhaphy in local-regional anesthesia was performed whitout any anti-adhesion device. In treated group, 12 consecutive WALANT flexor tendons repair, Dynavisc® was applied into the flexor sheath. All patients were evaluated: early and late complications, secondary surgery and at 30, 60 and 180 days after surgery by testing Total Active Motion (TAM), Quick-DASH questionnaire.

Results and Conclusions: Patients in study group had a statistically better recovery of finger motion at long time intervals, specially after 60 and 180 days from the tenedon surgery. The use of wide-awake and Dynavisc® doesn't correlate with increase particoular types of complication. The objectives of the study were to measure the efficacy and to check the safety of WALANT Dynavisc® by assessing adverse effects. CMC-PEO gel can reduce peritendineous scar tissue. Long term hydrolysis (> 30 days) can protect, in our opinion, the surgical site from fibroblasts migration and differentiation, during an important period of collagen synthesis (4th post-operative week). The encouraging results confirmed the Dynavisc effectiveness in flexor tendon surgery.