The use of indomethacin in the prevention of postoperative radioulnar synostosis after distal biceps repair.

BACKGROUND: This study evaluated the incidence of symptomatic radioulnar synostosis/heterotopic ossification after distal biceps tendon repair in patients receiving indomethacin prophylaxis. We hypothesized that indomethacin use postoperatively would decrease the occurrence of symptomatic synostosis. METHODS: A single-center retrospective record review identified 124 patients undergoing distal biceps repair between 2011 and 2014. Patients were analyzed for administration of indomethacin, contraindications to administration, age, time to surgery, fixation method, medical comorbidities, and development of symptomatic synostosis. Oral indomethacin (75 mg, once daily) was prescribed postoperatively for 10 to 42 days per each attendings' protocol. RESULTS: After analysis, 112 patients met the inclusion criteria, with 7 undergoing a 1-incision distal biceps repair and 105 undergoing a 2-incision repair. Of those, 104 received indomethacin postoperatively, with a synostosis rate of 0.96% compared with 37.50% for the untreated group (P < .001). No statistically significant difference was found between fixation methods and synostosis. One patient with synostosis was a single-incision repair, and 3 were 2-incision suture bridge repairs. Three patients with synostosis had relative contraindications to administration of indomethacin, including concomitant warfarin use, clopidogrel use, and ulcerative colitis. CONCLUSION: Indomethacin use after distal biceps repair was associated with a statistically significant reduction in the rate of symptomatic radioulnar synostosis and did not have any associated adverse effects, including gastrointestinal bleeding or rerupture, despite prolonged use of up to 6 weeks. This study represents the largest study to report the outcomes of patients undergoing distal biceps repair with concomitant synostosis prophylaxis using indomethacin.

Acellular dermal regeneration template for soft tissue reconstruction of the digits.

PURPOSE: Trauma to the digits often leaves soft tissue defects with exposed bone, joint, and/or tendon that require soft tissue replacement. The objective of this study was to evaluate the effectiveness of acellular dermal regeneration template combined with full-thickness skin grafting for soft tissue reconstruction in digital injuries with soft tissue defects. METHODS: Acellular dermal regeneration template was used to reconstruct digital injuries with exposed bone, joint, tendon, and/or hardware not amenable to treatment with healing by secondary intention, rotation flaps, or primary skin grafts. Acellular dermal regeneration template was applied to 21 digits in 17 patients. Nineteen digits had exposed bone, 8 digits had exposed tendon, 6 digits had exposed joints, and 2 digits had exposed hardware. The acellular dermal regeneration template was sutured over the soft tissue defect. Over 3 weeks, a neodermis formed. The superficial silicone layer of the acellular dermal regeneration template was removed, and the digits received full-thickness epidermal autografting with cotton bolster. RESULTS: The duration of postoperative follow-up extended to a minimum of 12 months. For the injury sites where acellular dermal regeneration template was applied, the total area of application ranged from 1 cm(2) to 24 cm(2), with the largest individual site measuring 12 cm(2). Twenty of 21 digits demonstrated 100% incorporation of the acellular dermal regeneration template skin substitute. One digit that had sustained multilevel trauma developed necrosis requiring revision amputation. Full-thickness epidermal autografting was performed an average of 24 days after acellular dermal regeneration template skin substitute application and demonstrated a 100% take in 16 of 20 digits and partial graft loss of 15% to 25% in 4 of 20 digits that did not require further treatment. CONCLUSIONS: Acellular dermal regeneration template combined with secondary full-thickness skin grafting is an effective method of skin reconstruction in complex digital injuries with soft tissue defects involving exposed bone, tendon, and joint. The neodermis increases tissue bulk and facilitates epidermal autografting with digital injuries that otherwise would require flap coverage or skeletal shortening of the digit. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.