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Repair of distal triceps tendon rupture with human acellular dermal matrix (ADM)

Andrea Atzei

Department of Orthopedic, University of Verona, Italy

Giampietro Bertasi

Department of Orthopedic, University of Verona, Italy

E-mail : bertasi.g@sis.it

DOI: 10.15761/TEC.1000112

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Abstract

The following case presentation involves treatment of a ruptured distal triceps tendon with this human ADM, DermACELL®.

Introduction

Distal triceps tendon ruptures can cause long-term disability for the patient which can be further complicated by difficulties for the surgeon in developing a diagnosis as well as determining the severity of the injury [1,2]. Distal triceps tendon ruptures are often caused from a fall onto an outstretched hand or trauma to the posterior of the arm, with pulling or tearing at the osseous tendon insertion [1,3]. Other studies report intramuscular injury or injury at the myotendinous junction as another possible cause of the rupture [1,3]. Treatment of these ruptures typically includes surgery to reattach the ruptured triceps tendon to the olecranon of the elbow [4]. This is commonly achieved with the use of sutures that are passed through tunnels in the olecranon [4]. Surgeons often augment the tendon with an allograft in patients with chronic tears or undergoing revision surgery [5].

An alternative treatment for ruptured distal triceps tendon is a matrix scaffold for new tissue generation, an acellular human dermal matrix (ADM) allograft as reviewed by Wainwright and Bury [6]. Decellularized human skin has been used for a variety of medical procedures, primarily involving wound healing, soft tissue reconstruction, and sports medicine applications [7-10].

Case study

Patient

  • 42 year old, Male.

Diagnosis

  • Failed repair of total full-thickness laceration of the distal tendon of the triceps. (Figure 1)
  • Original failed repair had been attempted 3 months earlier.

Figure 1. Full-thickness laceration of the distal tendon of the triceps.

Treatment

  • The scar tissue was resected with a resulting 6 cm gap between the tendon stumps.
  • Two core sutures (Ethibond 2, Ethicon, Somerville, NJ, USA) were placed at both sides of the tendon. (Figure 2)
  • One trimmed piece of 6cm x 6cm non-meshed DermACELL (LifeNet Health, Virginia Beach, VA, USA) was weaved through the tendon mid-structure for augmentation and a second custom fit piece of 6cm x 6cm non-meshed DermACELL was laid over the repair site. (Figures 3 and 4)
  • A small incision was made to let the exudate drain.
  • Elbow was splinted in 90° flexion for 3 weeks and progressive flexion was allowed to achieve full flexion in the following 3 weeks. (Figure 5)

Figure 2. Core sutures were placed at both sides of the tendon.

Figure 3. DermACELL was weaved through the tendon mid-structure.

Figure 4. A second custom fit piece of DermACELL was laid over the repair site.

.

Figure 5. 3 month MRI demonstrates intact distal triceps brachialis tendon.

Outcome

  • Postoperative course was uneventful except for a prolonged swelling over olecranon bursa, healed spontaneously after 3 weeks
  • By 6 months post-op, the patient regained 87% ROM and 70% strength

References

  1. van Riet RP, Morrey BF, Ho E, O’Driscoll SW (2003) Surgical treatment of distal triceps ruptures. J Bone Joint Surg Am 85A:1961-1967. [Crossref]
  2. Rajasekhar C, Kakarlapudi TK, Bhamra MS (2002) Avulsion of the triceps tendon. Emerg Med J  19: 271-272.
  3. Sollender JL, Rayan GM, Barden GA (1998) Triceps tendon rupture in weight lifters. J Shoulder Elbow Surg 7: 151-153. [Crossref]
  4. Bava ED, Barber FA, Lunc ER (2012) Clinical outcome after suture anchor repair for complete traumatic rupture of the distal triceps tendon. Arthroscopy 28: 1058-1063. [Crossref]
  5. Vidal AR, Allen A (2004) Biceps tendon and triceps tendon injuries. Clin Sports Med 23: 707-722. [Crossref]
  6. Wainwright DJ, Bury SB (2011) Acellular Dermal Matrix in the Management of the Burn Patient. Aesthet Surg J 31: 13S-23S.
  7. Wong I, Burns J, Snyder S (2010) Arthroscopic GraftJacket Repair of Rotator Cuff Tears.  J Shoulder Elbow Surg 19: 104-109. [Crossref]
  8. Wilkins R (2010) Acellular Dermal Graft Augmentation in Quadriceps Tendon Rupture Repair. Curr Orthop Pract 21: 315-319
  9. Lee, Daniel (2007) Achilles Tendon Repair with Acellular Tissue Graft Augmentation in Neglected Ruptures. J Foot Ankle Surg 46: 451-455. [Crossref]
  10. Sbitany H, Sandeen S, Amalfi A, Davenport M, Langstein H (2009) Acellular Dermis-Assisted Prosthetic Breast Reconstruction versus Complete Submuscular Coverage: A Head-to-Head Comparison of Outcomes. Plast Reconstr Surg 124: 1735-1740. [Crossref]

Editorial Information

Editor-in-Chief

Guo-Gang Xing
Peking University

Article Type

Case Study

Publication history

Received date: May 10, 2016
Accepted date: June 03, 2016
Published date: June 06, 2016

Copyright

© 2016 Giampietro Bertasi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Atzei A, Bertasi G (2016) Repair of distal triceps tendon rupture with human acellular dermal matrix (ADM). Trauma Emerg Care 1: DOI: 10.15761/TEC.1000112.

Corresponding author

Giampietro Bertasi

Department of Orthopedic, University of Verona, Italy, Tel: +1780 735 4660 +39 (045) 600 1035; Fax: +39 (045) 445 0001

E-mail : bertasi.g@sis.it

Figure 1. Full-thickness laceration of the distal tendon of the triceps.

Figure 2. Core sutures were placed at both sides of the tendon.

Figure 3. DermACELL was weaved through the tendon mid-structure.

Figure 4. A second custom fit piece of DermACELL was laid over the repair site.

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Figure 5. 3 month MRI demonstrates intact distal triceps brachialis tendon.