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Saraiva S, Rénio F, Pereira P, Santos P, Paula CTB, Ramalho A, Serra AC, Fonseca AC. Tackling the Problem of Tendon Adhesions: Physical Barriers Prepared from α-Amino Acid-Based Poly(ester amide)s. Polymers (Basel) 2025; 17:395. [PMID: 39940597 PMCID: PMC11821251 DOI: 10.3390/polym17030395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2024] [Revised: 01/25/2025] [Accepted: 01/29/2025] [Indexed: 02/16/2025] Open
Abstract
In this work, electrospun membranes of α-amino acid based poly(ester amide)s (AAA-PEAs) from L-alanine (PEA_ala) or L-phenylalanine (PEA_phe) were successfully prepared to be used as physical barriers in the orthopedic field. Also, blends of these two polymers were used in different weight ratios (25:75, 50:50 and 75:25) to obtain physical barriers with different properties. All membranes had a suitable pore size to prevent fibroblast infiltration, and their porosity and permeability values were in a range that allowed the passage of nutrients. The membrane made from a blend of 25%wt of PEA_ala and 75% wt of PEA_phe showed the highest value of swelling capacity, suggesting a higher lubricant feature. The same membrane suffered a more pronounced degradation, as evidenced by the in vitro enzymatic degradation tests. All membranes showed suitable toughness values, a crucial property with regard to application. In vitro cytotoxicity tests performed with a NIH3T3 fibroblast cell line revealed decreased cell viability after 7 days, suggesting that these membranes are not ideal substrates to promote fibroblast adhesion and proliferation. These membranes as physical barriers represent a significant advance in the field given the limited literature on electrospun AAA-PEAs and their use to prevent tendon adhesion.
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Affiliation(s)
- Sofia Saraiva
- Centre for Mechanical Engineering, Materials and Processes (CEMMPRE), ARISE, Department of Chemical Engineering, University of Coimbra, Pólo II, Rua Sílvio Lima, 3030-790 Coimbra, Portugal; (S.S.); (F.R.); (P.P.); (P.S.); (C.T.B.P.); (A.C.S.)
| | - Francisca Rénio
- Centre for Mechanical Engineering, Materials and Processes (CEMMPRE), ARISE, Department of Chemical Engineering, University of Coimbra, Pólo II, Rua Sílvio Lima, 3030-790 Coimbra, Portugal; (S.S.); (F.R.); (P.P.); (P.S.); (C.T.B.P.); (A.C.S.)
| | - Patrícia Pereira
- Centre for Mechanical Engineering, Materials and Processes (CEMMPRE), ARISE, Department of Chemical Engineering, University of Coimbra, Pólo II, Rua Sílvio Lima, 3030-790 Coimbra, Portugal; (S.S.); (F.R.); (P.P.); (P.S.); (C.T.B.P.); (A.C.S.)
- IPN, Instituto Pedro Nunes, Associação para a Inovação e Desenvolvimento em Ciência e Tecnologia, Rua Pedro Nunes, 3030-199 Coimbra, Portugal
| | - Patrícia Santos
- Centre for Mechanical Engineering, Materials and Processes (CEMMPRE), ARISE, Department of Chemical Engineering, University of Coimbra, Pólo II, Rua Sílvio Lima, 3030-790 Coimbra, Portugal; (S.S.); (F.R.); (P.P.); (P.S.); (C.T.B.P.); (A.C.S.)
| | - Carlos T. B. Paula
- Centre for Mechanical Engineering, Materials and Processes (CEMMPRE), ARISE, Department of Chemical Engineering, University of Coimbra, Pólo II, Rua Sílvio Lima, 3030-790 Coimbra, Portugal; (S.S.); (F.R.); (P.P.); (P.S.); (C.T.B.P.); (A.C.S.)
- IPN, Instituto Pedro Nunes, Associação para a Inovação e Desenvolvimento em Ciência e Tecnologia, Rua Pedro Nunes, 3030-199 Coimbra, Portugal
| | - Amílcar Ramalho
- Centre for Mechanical Engineering, Materials and Processes (CEMMPRE), ARISE, Department of Mechanical Engineering, University of Coimbra, Pólo II, Rua Luís Reis Santos, 3030-788 Coimbra, Portugal;
| | - Arménio C. Serra
- Centre for Mechanical Engineering, Materials and Processes (CEMMPRE), ARISE, Department of Chemical Engineering, University of Coimbra, Pólo II, Rua Sílvio Lima, 3030-790 Coimbra, Portugal; (S.S.); (F.R.); (P.P.); (P.S.); (C.T.B.P.); (A.C.S.)
| | - Ana C. Fonseca
- Centre for Mechanical Engineering, Materials and Processes (CEMMPRE), ARISE, Department of Chemical Engineering, University of Coimbra, Pólo II, Rua Sílvio Lima, 3030-790 Coimbra, Portugal; (S.S.); (F.R.); (P.P.); (P.S.); (C.T.B.P.); (A.C.S.)
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Kang A, McKnight RR, Fox PM. Flexor Tendon Injuries. J Hand Surg Am 2024; 49:914-922. [PMID: 39093238 DOI: 10.1016/j.jhsa.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 08/04/2024]
Abstract
Flexor tendon injuries are complex, and management of these injuries requires consideration of the surgical timing, injury location, approach, and soft tissue handling. Complications are common, including adhesions, tendon rupture, infection, and a high reoperation rate for zone 2 repairs. Special considerations are given to chronic ruptures, concomitant fractures, and pediatric cases. We discuss current concepts that may improve patient outcomes.
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Affiliation(s)
| | - Richard Randall McKnight
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA; Robert A. Chase Hand and Upper Limb Center, Stanford University Medical Center, Stanford, CA
| | - Paige M Fox
- Robert A. Chase Hand and Upper Limb Center, Stanford University Medical Center, Stanford, CA; Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA; Division of Plastic Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
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Chen J, Tang JB. Complications of flexor tendon repair. J Hand Surg Eur Vol 2024; 49:158-166. [PMID: 38315135 DOI: 10.1177/17531934231182868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
This article reviews and highlights complications of flexor tendon repairs. Although the outcomes of flexor tendon repairs have improved over the years, fair or poor functional outcomes are seen, especially in patients whose trauma involves multiple structures of the hand and in zone 5 with multiple tendon lacerations. Rupture of the flexor tendon after repair is no longer a major problem if current repair principles are carefully adhered to. Different degrees of adhesion formations and interphalangeal (IP) joint stiffness still occur in a few patients. Early active postoperative mobilization and use of a shorter splint with sparing of the wrist are effective measures to prevent adhesion formation and IP joint stiffness. Given the overall poor results and high rate of complications with flexor digitorum profundus (FDP) repairs in zone 1, a direct repair of the FDP tendon to any short remnant of the distal insertion with 10-strand or even stronger core suture repair is adopted by many units.
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Affiliation(s)
- Jing Chen
- The Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jin Bo Tang
- The Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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