Plastic and Reconstructive
Innovative Care
Restores Form and Function
VersaWrap® Hydrogel Sheet and VersaCoatTM Flowable Hydrogel facilitate tissue gliding following plastic and reconstructive procedures intended to restore and remodel soft tissues. The VersaWrap Hydrogel Sheet provides conformable, uniform coverage across planar and circumferential anatomy, while the VersaCoat Flowable Hydrogel allows precise, discrete application onto delicate, complex geometries, or approximated tissues.
Plastic and reconstructive surgery demands soft-tissue protection across a uniquely diverse range of anatomical sites and procedure types. Whether protecting a nerve coaptation during flap reconstruction, shielding a decompressed nerve from recurrent tethering, or preserving tissue plane integrity in revision cases, postoperative tethering poses a direct threat to the functional outcomes these procedures are designed to restore. VersaWrap Hydrogel Sheet and VersaCoat Flowable Hydrogel provide a sustained gliding surface that reduces friction between adjacent structures, prevents tethering, and fully bioresorbs throughout healing, leaving only the body’s natural tissues behind.
The following cases demonstrate VersaWrap Hydrogel Sheet and VersaCoat Flowable Hydrogel across the reconstructive spectrum, from DIEP flap breast reconstruction with nerve coaptation to occipital nerve decompression for chronic migraine and revision neurolysis with second-look visualization.
Breast Reconstruction
Patient
The patient is a 60-year-old woman with bilateral ductal carcinoma in situ who underwent bilateral skin sparing mastectomies. Her medical history is significant only for Hashimoto’s thyroid disease. She had bilateral deep inferior epigastric perforator (DIEP breast reconstruction) with transfer of one intercostal nerve into one abdominal cutaneous nerve on each side.
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Technique
One (1) 2 x 2 in. VersaWrap Nerve Protector was cut in half into two (2) 1 x 2 in. pieces. The VersaWrap Nerve Protector pieces were shaped into a funnel using the accompanying paper backing. The VersaWrap Nerve Protector funnels allowed the abdominal cutaneous nerves to be coapted to a 3cm graft during flap inset, on each side. Once the nerves were together, the VersaWrap Nerve Protector paper backing was removed and the VersaWrap Nerve Protector sheet adhered to the nerve coaptions, supporting the repair. Without VersaWrap Nerve Protector, the graft would have been 6-7cm for proper visualization.
Results
Patient 1 was discharged from the hospital on postoperative Day 4 in good condition. Incisions are healed and she is very happy with the appearance of her breasts two (2) months after surgery. She has returned to gardening and walking daily at two months. Sensation has not returned to her flap tissues yet but is not expected before 3-6 months.
Figs. A) VersaWrap funnel being prepared for wrapping around nerve graft from intercostal nerve; B) Flap being lowered into breast cavity with VersaWrap guiding abdominal cutaneous nerve to nerve graft; C) Nerve coaptation supported by VersaWrap. The paper used to support VersaWrap funnel is removed leaving only the VersWrap sheet around the nerve coaptation.
Second Look: rTSA, HO & Axillary Neurolysis
Patient Initial Injury
The 53-year-old male patient sustained a right proximal humerus fracture falling off a roof in the remote past followed by ORIF of the proximal humerus. This ORIF procedure was later converted to a reverse total shoulder arthroplasty that was complicated heterotopic ossification. Heterotopic bone excision and revision arthroplasty was performed by the original shoulder surgeon. Unfortunately, the patient sustained an axillary nerve injury resulting in profound weakness of the deltoid muscle and pain. After no recovery at six months, the patient underwent decompression of the quadrilateral space with neurolysis of the axillary nerve branches and a triceps branch to axillary nerve transfer. VersaWrap was applied around the axillary nerve to mitigate expected scarring and prevent adherence leading to painful lack of excursion with shoulder motion.
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Second Look Surgery
One year after the original fracture and surgery, the patient presented with recurrent heterotopic ossification (HO) with a completely ankylosed joint and glenohumeral arthritis that needed to be resected. In conjunction with their shoulder surgeon, another neurolysis was performed of the axillary nerve through a posterior and anterior approach to the quadrilateral space. This was to protect the axillary nerve and its functioning nerve transfer from injury during the resection as well further release it from tethered points.
Results
The ‘second look’ visualization of the axillary nerve branch in the quadrangular space where VersaWrap was originally applied showed a lack of scarring in comparison to non VersaWrap covered tissues more superficially in the approaches having a substantial amount of scarring. The surgeons expected to find an extensive amount of scar tissue requiring intense dissection to free the axillary nerve. Instead, the surgeons were able to circumferentially finger dissect the axillary nerve with minimal effort within the space.
Migraine
Patient
A 63-year-old female who presented with chronic intractable migraine headaches originating from the occipital trigger site. The headaches persisted previously for thirty (30) years. The patient had up to eight (8) episodes of severe headaches every month that would last days to weeks. The headaches did not get better with medication, radiofrequency ablation, nerve blocks, and Botox injections.
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Treatment
The patient underwent decompression and neurolysis of bilateral greater occipital nerves. VersaWrap was used to wrap the nerves to reduce postoperative scarring.
Results
At one-month follow-up, the patient has only had one mild self-limiting headache and is otherwise headache free. VersaWrap served as a barrier and nerve protector to reduce scarring with good postoperative outcomes.
Figs. A) Application of VersaWrap around left greater occipital nerve; B) and right greater occipital nerve; C) VersaWrap wrapped around both nerves
Always refer to the complete instructions for use for the complete clinical instructions.
This content is for informational purposes only and is not intended to constitute medical advice. As with any medical device, there are multiple factors affecting patient outcomes, including post-operative recovery time and activity level. Patient outcomes may vary based upon, among other factors, the nature and extent of loss or damage, the time between injury or damage and surgery, and the natural course of the patient’s recovery.
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