Grants We Funded

Abstract
Volar hand injuries with marked soft tissue loss, including specifically the pulley system and the flexor tendon structures, pose a unique problem to the reconstructive hand surgeon. Even with optimum surgical treatment and physical therapy, a significant portion of these individuals are plagued by chronic pain, stiffness, and decreased range of motion, which are associated with significant loss of vocational capacity and quality of life. The gold standard for repair of these injures continues to be primary repair, however when the amount of tissue loss is too great, this is not achievable. Innovative operative techniques are required to restore both form and physical function to this patient population. Herein, we describe a novel reconstructive approach to volar hand injury with significant soft tissue loss through the use of composite flexor tendon allografts (CFTAs) consisting of intrasynovial flexor tendon and associated pulley structures and fibro-osseous sheath with intact volar plates and periosteum as a single functional unit with a distal bone attachment. The overall hypothesis of our work is that CFTAs possess unique properties which may allow for decreased cicatricial scar through the pulley system, improved tendon gliding, and decreased need for multiple operative procedures and donor site morbidity compared with conventional multi-stage silastic rod tendon reconstruction. This approach represents an important step towards designing an ideal material for complex flexor tendon reconstruction, which takes advantage of an intrasynovial flexor tendon in its native fibro-osseous sheath without the need for additional donor morbidity using a construct which can be engineered to have minimal tissue reactivity, negligible potential for disease transmission, and improved tendon healing properties versus standard tendon allograft.

Biography
Dr. DeGeorge graduated summa cum laude from The College of William and Mary and attended Jefferson Medical College and Thomas Jefferson University where he completed his medical education and a Ph.D. in Molecular Pharmacology and Structural Biology. He then completed his residency training in the Department of Plastic Surgery at the University of Virginia. Dr. DeGeorge went on to complete fellowship training in Hand and Microvascular Surgery in the Department of Orthopaedic Surgery at the Mayo Clinic. He returned to the University of Virginia to join the faculty at the UVA Hand Center. Dr. DeGeorge’s areas of expertise include brachial plexus and peripheral nerve surgery and hand, wrist, and forearm reconstruction following trauma. He also specializes in microsurgery and arthroscopy of the upper extremity. His research interests include clinical trial design and outcomes research, complementary and alternative health interventions, articular cartilage repair and replacement techniques, and allograft tendon, cartilage, and dermis studies. Dr. DeGeorge has received additional training in clinical trial design and research methodology. He has received numerous awards for his research and academic excellence.