Upper Extremity
Innovative Care
That Moves With Every Gesture
VersaWrap® Hydrogel Sheet and VersaCoatTM Flowable Hydrogel preserve desired soft tissue gliding to allow early and active motion following upper extremity procedures. 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.
In hand, wrist, elbow, and shoulder procedures, postoperative tethering between injured tendons, ligaments, muscle, decompressed nerves, and surrounding structures directly threatens mobility, dexterity, and sensation critical to recovery. VersaWrap Hydrogel Sheet and VersaCoat Flowable Hydrogel provide a sustained gliding surface that reduces friction between adjacent tissue planes, 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 a range of upper extremity procedures, from complex flexor tendon repair and tenolysis to cubital tunnel release and multi-structure trauma reconstruction, including second-look evidence of sustained gliding surface performance.
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 tethering leading to painful lack of excursion with shoulder motion.
View Outcomes
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 procedure 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.
Complex Table Saw Injury: Flexor Tenolysis
Patient
Patient had a complex table saw injury to multiple digits, including a laceration of the thumb FPL and digital nerves, the middle finger FDP tendon and digital nerves, and the loss of the ring finger entirely.
View Outcomes
Treatment
Initial surgery required repair of the FPL, FDP, and multiple digital nerves, and took place prior to the Surgeon using VersaWrap. A few months postoperatively, the patient underwent a flexor tenolysis of the middle FDP. VersaWrap was applied as a sheet around the FDP circumferentially. Excellent gliding through the VersaWrap sheet was visualized and confirmed.
Results
At 10 days after surgery, surgeon and hand therapists in rehab observed “far less” inflammation and edema, and increased soft tissue suppleness than the surgeon expected. Patient reported less pain than surgeon typically sees and notes an increased ability to rehab more aggressively at earlier timepoints.
Hand Stab: Tendon, Nerve, & Artery Repair
Patient
Patient tripped and fell while holding a glass bottle and landed palm first, causing the glass shard to stab directly through the palm. In total, the patient sustained lacerations to 4 flexor tendons, 2 common digital nerves, and multiple lacerations to the palmar arch and 2 common digital artery branches.
View Outcomes
Treatment
Patient underwent emergent repair of the FDS and FDP tendons to the index and middle fingers; common digital nerves to the 2nd and 3rd webspaces including nerve allograft; and revascularization via repair of the superficial palmar arch artery and repair of the common digital arteries to the 2nd and 3rd webspaces. Due to the small space with numerous overlapping injured structures, VersaWrap was applied in layers around the tendons and nerves to prevent adhesions and permit early range of motion.
Results
In a repair this layered and complex, the surgeon typically expects 6 months of rehab followed by a revision tenolysis surgery. However, in this case with VersaWrap, patient achieved full finger flexion ROM within several months and no revision tenolysis was necessary after this highly complex repair.
Tenolysis following Trigger Finger Releases
Patient/Injury
A guitarist presented with loss of complete finger flexion following trigger finger releases performed at an outside institution, causing inability to flex the fingers to the palm and make a complete fist. Consequently, there was loss of range of motion, dexterity, and grip strength. The patient struggled to play guitar, had difficulty typing, and was unable to ride a motorcycle.
View Outcomes
Treatment
Patient underwent a tenolysis for FDS and FDP flexor tendons of the middle finger and ring finger. VersaWrap was then weaved under the FDP, between FDP and FDS, and on top of the FDS, covering both tendons circumferentially throughout the operative field.
Results
Patient recovered greater than 90o of flexion at PIP and MCP joints, regained total composite finger flexion, and reported being exceedingly happy. Patient was able to return to playing guitar and riding a motorcycle successfully.
Acute Zone V Flexor Tendon Laceration with Second Look One Year Later
Initial Procedure
A 68-year-old patient sustained an acute flexor pollicis longus (FPL) tendon laceration when he fell on glass, cutting his right wrist. During the operative repair VersaWrap (a hyaluronic acid (HA)/alginate sheet with activating solution) was applied over the repair site to limit unwanted postoperative tethering.
Before undergoing distal radius fracture operative fixation for a separate injury one year later, allowing direct visualization of the healed tendon repair.
View Outcomes
Results in 10 Weeks
At his final follow up appointment (10 weeks postop), he was able to make a full composite fist and had 30 degrees of flexion about the right thumb IPJ when compared to 45 degrees on the contralateral extremity. He had resumed normal activity and was cleared without restrictions.
Second Procedure
Approximately one year later, the patient sustained a right distal radius fracture after falling off a ladder and underwent a right distal radius open reduction and internal fixation. The exposure revealed the previously repaired FPL, which was intact. The repair was visualized and noted to have healed entirely. There were no adhesions in the area where VersaWrap had been applied. Proximal to the placement of VersaWrap, though, adhesions were noted.
Recurrent Cubital Tunnel Release
Patient
ThA 68-year-old male with a history of two previous cubital tunnel releases who presented with persistent symptoms related to ulnar nerve compression at the elbow.
View Outcomes
Treatment
Patient underwent repeat cubital tunnel release with submuscular transposition of the ulnar nerve. VersaWrap was used to wrap the ulnar nerve to reduce postoperative scarring.
Results
The surgeon stated that VersaWrap protected the nerve from tethering to surrounding tissues. At six (6) weeks followup, the patient was improved with positive postoperative outcomes.
Ruptured Flexor Digitorum Profundus (FDP) with a Hematoma Around Common Digital Nerves
Patient
The patient is a 73-year-old male who was walking a dog when the dog leash yanked suddenly, causing immediate pain in the patient’s dominant right hand.
Pre-operative assessment revealed the patient had a swollen and slightly bruised small finger with absent FDP function. Sensation was present throughout all fingers.
Surgical exploration was conducted at 26 days post-injury and the small finger FDP was found ruptured in the palm, at the transverse carpal ligament level. A small organized hematoma was found in the palm, around the common digital nerves to the small finger.
View Outcomes
Treatment
Red arrow is edge of transverse carpal ligament, opened to allow access to tendon in canal; black arrow is tendon repair site; blue arrow is nerve and vessel crossing over tendon (hematoma has already been washed away). The small finger FDP was repaired and neurolysis of the digital nerves to the small finger was conducted, debriding the hematoma. VersaWrap was wrapped around the tenorrhaphy site and digital nerves where neurolysis was conducted. Post-operatively a routine flexor tendon rehabilitation protocol was followed along with supervised hand therapy.
Results
At five months follow-up, the patient has excellent active motion. The patient makes a full composite fist with no flexion contractures. The soft tissue envelope is in excellent condition with normal sensation in the digital nerves to the injured small finger.
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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