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Southlake, TX, United States

McKenna R.W.,Riordan McKenna Institute | Chandler T.,North Central Texas Orthopedics Sports Medicine
Techniques in Shoulder and Elbow Surgery | Year: 2015

Management of the rotator cuff-deficient shoulder remains challenging particularly for younger patients with higher functional demands. Patients presenting with signs and symptoms of cuff tear arthropathy (CTA) are frequently treated with reverse, total, or hemishoulder arthroplasty. Life expectancy must be taken into consideration when deciding on the treatment path for high-demand patients, particularly in light of significant complication rates and poor revision strategies for reverse shoulder arthroplasty. Subsets of patients presenting with early CTA stage IA (Seebauer Classification, Burkhart type I) are suitable candidates for a less-invasive approach. Intact fulcrum kinematics provide a compensated, deltoid-driven functional improvement when primary and secondary pain generators are addressed. Over the past 7 years, we have followed strict stage-specific selection criteria and treated these patients with a humeroacromial inlay arthroplasty (HemiCAP), which preserves the congruity of the articular surface with minimal bone resection and leaves a clinical exit strategy into total shoulder arthroplasty or hemishoulder arthroplasty if necessary. The procedure allows for a deltoid-splitting approach leaving the subscapularis untouched. This has positive implications for postoperative recovery and prevents possible approach-related complications associated with a subscapularis tenotomy. Patient selection, technical aspects, and adjuvant procedures play an important role and make superior humeral head inlay arthroplasty a safe, effective, and reproducible joint-preserving solution for early-stage compensated CTA. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source

Riordan N.H.,MediStem Panama Inc. | Riordan N.H.,Riordan McKenna Institute | George B.A.,Riordan McKenna Institute | Chandler T.B.,Riordan McKenna Institute | McKenna R.W.,Riordan McKenna Institute
Journal of Translational Medicine | Year: 2015

Introduction: Non-healing wounds can pose a medical challenge as in the case of vasculopathic venostasis resulting in a surgical ulcer. When traditional approaches to wound care fail, an amniotic patch (a dehydrated tissue allograft derived from human amnion) can function as a biologic scaffold to facilitate and enhance tissue regeneration and rehabilitation. Background: Amniotic AlphaPatches contain concentrated molecules of PGE2, WNT4, and GDF-11 which have angiogenic, trophic, and anti-inflammatory effects on tissues that may be useful in enhancing wound healing. Aim-case report: We present a case of a severe non-healing surgical wound in a 78-year-old male 17 days post right total knee arthroplasty. The full-thickness wound exhibited a mobile flap, measured 4 cm long × 3 cm wide, and showed undermining down to patellar tissue. We treated the wound conservatively for 6 weeks with no evidence of wound healing. Upon failure of the conservative treatment, two amniotic AlphaPatch (Amniotic Therapies, Dallas, TX, USA) were applied to the wound, and the wound healed completely in 10 weeks. Methods: In the OR, the wound was irrigated with three liters of double antibiotic solution under pulse lavage. Two dry amniotic AlphaPatch (4 cm × 4 cm) were placed over the wound with Acticoat applied on top. Results: At the two-week follow-up visit (following the incision and drainage of the wound dehiscence and application of the amniotic AlphaPatch), a central scab had formed centrally in the wound dehiscence area. At the four-week follow-up visit, the wound dehiscence area had completely scabbed over with no open areas left. At the eight-week follow-up visit, the scab had just fallen off, and the wound was healing well with immature skin representing the size of a penny. At the ten-week follow-up visit, the wound was completely healed. Discussion/conclusion: Sterile, dehydrated amniotic tissue AlphaPatches (containing trophic factors known to enhance wound healing) have proven effective in completely healing an otherwise non-healing wound in a 78-year-old male who failed six weeks of conservative wound care treatment. © 2015 Riordan et al. Source

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