Delayed Tricep Repair Using Dermal Allograft: Technique and Case Examples.

Abstract

An acellular dermal matrix is a biological graft composed of several components present in the dermis such as collagen fibers, elastin, fibronectin, and hyaluronic acid that serve as support for cellular repopulation that will gradually become vascularized. This provides mechanical resistance and improves suture retention. With this article we aim to present 2 cases, and our technique, in which a rupture of the distal triceps tendon occurred, patients presented late due to usual insurance authorization delays, and then required delayed surgical repair by means of dermal acellular matrix grafting in order to bridge the substantial gap due to tricep proximal retraction. The first case report describes a 55-year-old male with abetalipoproteinemia who suffered an unclear injury to his right triceps tendon and apparently an olecranon bursitis and/or tricep tendonitis. Surgical intervention involved exploring the triceps tendon, revealing degenerative tissue and a detached muscle belly that was unrepairable, necessitating immediate reconstruction with a dermal allograft. The poor quality of the triceps tendon, weakened by cortisone injections, precluded primary repair, highlighting the rationale for graft reconstruction. The second case concerns a 54-year-old male, a gym owner and amateur bodybuilder, who suffered a fracture of the lateral epicondyle with avulsion of the distal triceps following a motorcycle accident. The patient underwent surgery with end-to-end suturing of the tendon and augmentation of the suture using acellular dermal matrix. The successful use of a dermal allograft in surgical reconstruction presents a promising solution in cases with insufficient tendon quality.