Arthrex® is a global medical device company dedicated to providing the finest quality engineered products and educational services for orthopaedic surgeons. In addition Arthrex has formed strategic alliances with innovative wound care companies to provide our surgeons and their patients with the best postoperative care.

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Product

Procedure

JumpStart antimicrobial wound dressings are composed of advanced microcurrent-generating technology used for the management of surgical incision sites. Microcell batteries made of elemental silver and zinc generate an electrical current when activated by conductive fluids, such as wound exudate, water-based wound hydrogels, saline, or water. This microcurrent is designed to support the body's natural electrical healing process and provide antimicrobial protection to assist with wound healing. JumpStart antimicrobial wound dressing's technology has demonstrated broad-spectrum bactericidal activity against antibiotic-resistant strains of wound isolates within 24 hours.

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Human

JumpStart® Antimicrobial Wound Dressings

Spine

JumpStart® antimicrobial wound dressing with Advanced Microcurrent Technology®* is used for the management of surgical incision sites. Embedded in the dressing are microcell batteries made of silver and zinc, which generates an electrical current and kills a broad spectrum of harmful pathogens, including multidrug-resistant and biofilm-forming bacteria to help reduce the risk of infection.
*Advanced MicroCurrent Technology is a registered trademark of Vomaris Wound Care, Inc.

video

JumpStart® Antimicrobial Wound Dressing

Cardiothoracic Surgery

JumpStart® FlexEFit™ Antibacterial Wound Dressing

Norman E. Waldrop III, MD, (Birmingham, AL) joins Chris Adams, MD, (Naples, FL) to discuss the experience and improved outcomes of using JumpStart® antimicrobial wound dressing, a technologically advanced antimicrobial surgical dressing that uses microcurrents to kill pathogens and advance healing of the surgical site.
Video Note: Chris Adams, MD, is now Arthrex® VP, Global Medical Education.

JumpStart™ Microcurrent Technology - Advanced Healing in Lower Extremity Procedures

JumpStart® Advanced Microcurrent Healing™

JumpStart® Advanced Microcurrent Healing™ - Surgical Site Infections (SSI)

JumpStart® Antimicrobial Wound Dressing Scientific Update

JumpStart® Antimicrobial Wound Dressing

Child (D)

Interfyl connective tissue matrix is used to fill irregular spaces or soft-tissue deficits resulting from wounds, trauma, or surgery. Interfyl connective tissue matrix is suited for a variety of surgical applications when there is a need to replace or supplement damaged or inadequate integumental tissue.
*Interfyl® is a product of Celularity Inc.

Intended for supplementing and/or replacing damaged or inadequate integumental tissue in surgical or wound applications, Interfyl® human connective tissue matrix is an allogeneic, decellularized matrix with a 10-year shelf life. It is available in both flowable and particulate formulas.&nbsp;
Interfyl is a registered trademark of Celularity Inc.&nbsp;

Interfyl® Human Connective Tissue Matrix

Interfyl human connective tissue matrix is an allogenic decellularized dehydrated particulate consisting of extracellular matrix components. It is available in particular and flowable formats with a ten year shelf life. This technology is intended for the replacement or supplementation of damaged or inadequate integumental tissue for surgical and advanced wound care applications, and provides a native extracellular matrix for cell attachment. Interfyl is derived from the chorionic plate of a placenta. This is excised, washed, dehydrated ground, and sterilized so that it contains no cells but remains structurally intact. Interfyl retains the fundamental structure and functional characteristics of connective tissue extracellular matrix to provide a scaffold for tissue repair. Interfyl can be applied directly to a wound site using its particulate form, or it can be reconstituted with saline in a 1 to 1 ratio and applied directly to the treatment area. This fills the gap in soft connective tissue, attracting monocytes to the tissue. Interfyl supports the transition of the tissue environment from pro-inflammatory to healing and remodeling. Interfyl has demonstrated a steady decrease in pro-inflammatory factors as well as a consistent increase in anti-inflammatory factors. Interfyl matrix is flowable, and particulate forms enable it to conform to challenging contours and fill irregular spaces or soft tissue deficits. Interfyl serves as a cell friendly structure for cell attachment. Cell attachment is a natural stimulus for the orderly release of growth factors to support the body's natural healing process.

Interfyl® Human Connective Tissue Matrix (CTM)

Kirk A. McCullough, MD (Leawood, KS), demonstrates augmentation with Interfyl® connective tissue matrix for the treatment of peroneal tendinopathy and tears.
Interfyl is a trademark of Celularity Inc.

Treatment of Peroneal Tendinopathy and Tears With Interfyl® Connective Tissue Matrix

All right, so Doctor Kirk McCullough here from Kansas City today we're going to go over the use of placental allograft tissue in the treatment of perineal tendinopathy and other pathology, including perineal tendon tears and including the use of both Biovance and Interfyl. So what you can see here is a prepared exposure posterolaterally of the perineal tendons and the tendon sheath. And so as we look at this a little bit closer, you can see that we've exposed and dissected through that perineal tendon sheath. Importantly leaving a cuff of tissue to be able to repair. Because the last thing we want to create obviously is iatrogenic instability and perineal tendon instability. When we've gone in and done an exposure. And so what you can see here, you can see the longus. And then as we look in here you can also then see this peroneus brevis longitudinal split tear that we've created. And then as we look a little bit more you can also see some of the retained fat and even arguably maybe some tenosynovitis tissue, which of course is important to be able to remove, including any elements of any low lying Peroneus brevis muscle belly that may cause functional impingement through the fibular groove. And so you can see the nice fibers deep in there if we rotate just a just a little bit of both, that deeper aspect of the sheath. But then also as we come down more distally, the calcaneofibular ligament. And so what we will do next is we will then start to remove some of this tissue and talk about how importantly, as we also include the repair of this longitudinal split, the reason why the use of placental allograft in situations like this is so critical, not only to allow for tendon healing and repair and regeneration, but more importantly, the limitations of scarring in this anatomic and anatomically limited groove. All right. And so now at this point, we have completed our synovectomy deep within the peritoneum, as well as a repair of that previously visualized split thickness tear of the peroneus brevis. You can see the longus right here. And so having performed that then this is the point at which then you have two options in being able to augment the repair of this, you can either use a Biovance sheet to be able to create a wrap around this repair, to separate it from the surrounding synovium, as well as from to separate it from the peroneus longus. Or you have the option which I will use frequently to then take your parantainen. And once you've created your parantainen closure, then to place Interfyl within that space to not only augment the healing of that tendon repair, but also, more importantly, to limit any recurrence of tenosynovitis within the sheath. And there have been frequent situations where, particularly with Stenosing tenosynovitis, I've been able to see the use of Interfyl after there's been gross debridement of the tenosynovitis and stenosing tenosynovitis tissue to then finish the fixation and the resolution of that chronic process on a microscopic level. And so at this point, if you had already completed the the Biovance sheath wrap of your tendon repair, you would then close parantainen and then be at this point or for the use of Interfyl with that closure of the peritoneum. This is now the point at which you can use your pre-mixed Interfyl that you've either mixed with, once again, sterile saline or just local anesthetic, such as 0.5% marcaine plane. You can now take this mix and then deep to that parantainen into that closure. I will then inject to then allow for that Interfyl to permeate that space in between both the peritoneum, the peroneus brevis, as well as the peroneus longus. And then, because of the ability of that graft to be able to to get into all of the defects and the various gaps in that, it allows it to interdigitate throughout that repair process, to allow it to be able to gain that scaffold and that anti-inflammatory effect. Taking the M1 macrophages to an M2 type phase as far as repair, if it was more of a chronic tenosynovitis case, or to very quickly get out of the acute inflammatory phase if it was a repair that you had done and get into that M2 type of repair and regenerative healing phase within that first 3 to 4 days, and then at this point with that, you can then continue your subdermal deep dermal closure and skin closure, and then also once again use that Interfyl in between that space between your closed peritoneum and the subcutaneous tissue.

Interfyl®  Human Connective Tissue Matrix

Kirk A. McCullough, MD (Leawood, KS), discusses the benefits and applications of augmentation with placental tissue products, including Biovance® amniotic membrane and Interfyl® connective tissue matrix (CTM), for foot and ankle orthopedic procedures. Biovance membrane serves as a natural scaffold that supports a high level of fibroblast and keratinocyte attachment,1 or as a barrier membrane during the wound regeneration process to support tissue growth.2 Interfyl CTM provides a native extracellular matrix for cell attachment.3
Biovance and Interfyl are trademarks of Celularity Inc.
References
1. Bhatia M, Pereira M, Rana H, et al. The mechanism of cell interaction and response on decellularized human amniotic membrane: implications in wound healing. Wounds. 2007;19(8):207-217.
2. Niknejad H, Peirovl H, Jorjani M, et al. Properties of the amniotic membrane for potential use in tissue engineering. Eur Cell Mater. 2008;15:88-99.
3. Pashuck ET, Mao Y, Kim K, John K, Smiell J, Bhatia MB. A human placenta-derived decellularized connective tissue matrix (CTM) supports cellular functions involved in wound healing processes. Paper presented at: Symposium on Advanced Wound Care; October 7-9, 2016. Las Vegas, NV.

Biovance Amniotic Membrane and Interfyl Connective Tissue Matrix for Foot and Ankle Procedures

Kirk McCullough to talk about the technique and application of using Biovance and Interfyl for foot and ankle orthopedic procedures. The reasons why we do it, and the reasons why you should do the same. So why placental products? Well, we know that scarring around the foot and ankle is a known issue. Certainly there are known wound healing issues not only with lateral hind foot exposures, such as those for calcaneal fractures, anterior exposures such as those for total ankle arthroplasty or pilon fracture fixation, and certainly posteriorly for Achilles exposures. And the issue we have frequently with chronic tendinopathy is with surgery. How do we functionally regenerate tissue rather than simply replace defects with fibrin based scar, which is typical for adult healing? Looking at some of the published literature on the use of human amniotic membranes and other placental products, Brian Cole et al. Went over some of the great basic science and early results, as well as potential clinical applications for the use of placental products, both in sports medicine and in other techniques. An additional good resource is the overview of the placenta in a Clinical sports medicine update in Ajsm for applications in orthopedics. Sports Medicine by James Alexander McIntyre et al. Which is a good resource as well. Another one from Doctor Steven Brigido is the use of Decellularized human placenta in full thickness wound repair and periarticular soft tissue reconstruction, and how we have been using some of these techniques, including the Biovance and Interfyl in regenerative healing techniques in the foot and ankle. So why is this an issue where the reality is that whether it's Robert Mathis, who had ten surgical procedures over an eight month time span, or Ryan Howard with the Philadelphia Phillies. Wound healing issues are not simply just a poor health. Poor medical access. Patient issue. So why Biovance and Interfyl? The reality is that an intact functional biologic scaffold and extracellular matrix is critical for regeneration and healing versus scar based repair. And this is true in all tissue types. But therefore how that tissue processing is done is critical as to whether or not it's going to perform and be utilized as that true scaffold that cells can recognize. So not unlike this construction scaffold on the outside of this home that's used to be able to repair the exterior. Although all the components are here, the nature in which those components are presented matter as to how those cells are. In this case, the workers are able to do their repairs to the house. So once again, similar to this, although all of the scaffolding techniques and all of the different components are present, if they're not presented in the right manner and they're all haphazard, such as in this photo, clearly this is not something that will be functional in order to achieve the end result. And so this is why Biovance and Interfyl, in our opinion, are critical for this. We remove the cellular components, but yet we retain the biochemical components and preserve that intact matrix that supports regeneration. By removing the cellular components, it minimizes any specific immune response. And by preserving that intact matrix, it minimizes nonspecific immune responses that otherwise can occur with other types of allograft tissue. So what makes Interfyl unique? It supports healing and functional tissue restoration. It does not contain amnion. And as far as the Korean difference, it's the only connective tissue matrix filler derived exclusively from the chorionic plate or the human umbilical cord, enters into the placenta and it's minimally processed and helps retain that fundamental structure. Just as we discussed with the scaffold is so critical for cell binding and cell function. Features exclusive to Interfyl is that it can be used with acute injuries and or chronic conditions. It's ready to use with room temperature storage as a ten year shelf life, and is intended for homologous use because it does not contain amnion and contains only those key components of connective tissue matrix presented in an appropriate structure that allows for that important cell binding characteristic. It's available in flowable and particulate forms, as you can see here, for a variety of surgical and non-surgical application needs. So once again, while Biovance and Interfyl. Well, even though we've theoretically talked about how that scaffold is important for cell binding, are we able to at least demonstrate in a lab based benchtop model that this actual cell binding occurs that can truly allow for that fetal type regeneration of tissue, rather than binding to a fibrin scaffold seen in adult scar based repair. So if you look at these studies, even just looking at looking at fibroblast and keratinocyte attachment. If you look at the Biovance compared to the dehydrated human amnion chorion membrane, what you can see is that Biovance is a cell friendly matrix that allows the proliferation of cells critical to wound healing. That is not present in that competitive product. Once again, looking at Biovance and Interfyl acting as this scaffold, not only is the Biovance study that we saw on the left present as far as cell viability, but you also can see that similar attachment with Interfyl once again demonstrating this cell friendly scaffold and the ability of the cells not only to initially attach, but then to divide and spread and continue their function five days after initial implantation. So what about in vitro studies that indicate Interfyl support cell function in soft tissue management? Once again, human monocytes on this connective tissue matrix not only show good adherence, but also show good viability even at day three compared to the control tissue culture plastic medium. Thank you very much.

Advanced Wound Care Technology

Interfyl®*Connective Tissue Matrix

Biovance human amniotic membrane allograft serves as a natural scaffold with an intact basement membrane that has been found to support a high level of fibroblast and keratinocyte attachment.1 Biovance amniotic membrane acts as a barrier membrane during the wound regeneration process and supports tissue growth.2
Reference
1. Bhatia M, Pereira M, Rana H, et al. The mechanism of cell interaction and response on decellularized human amniotic membrane: implications in wound healing. Wounds. 2007;19(8):207-217
2. Niknejad H, Peirovl H, Jorjani M, et al. Properties of the amniotic membrane for potential use in tissue engineering. Eur Cell Mater. 2008;15:88-99. 8
*Biovance® is owned by Celularity Inc.

Biovance® human amniotic membrane allograft is a natural extracellular matrix that acts as a scaffold for restoration of functional tissue and allows for host cell migration. Biovance 3L allograft is a triple-layer matrix with the same characteristics as Biovance allograft.
Biovance is a registered trademark of Celularity, Inc

Biovance® and Biovance 3L Human Amniotic Membrane Allograft

Biovance is an intact extracellular matrix, or ECM, that acts as a scaffold for restoration of functional tissue, and contains key proteins that allow for the migration of host cells. Biovance ArthroCell uses the same technology as Biovance and is composed of a triple layer construction. Biovance contains a protective cover and scaffold for cell attachment and biochemical signals, which can promote the healing of both chronic and traumatic wounds. Preparation of Biovance involves excising the amnion from a placenta. This is washed and sterilized so it contains no cells but remains structurally intact. Biovance provides the extracellular matrix, which contains collagen, elastin, and other extracellular matrix components. These proteins stimulate the migration of host cells to infiltrate the graft and promote tissue repair. When applied to a wound, this fills the gap in soft connective tissue, attracting monocytes to the tissue. Biovance supports the transition of the tissue environment from pro-inflammatory to healing and remodeling. Biovance has demonstrated a steady decrease of pro-inflammatory factors as well as a consistent increase in anti-inflammatory factors. Biovance scaffold serves as a cell friendly structure for cell attachment. Cell attachment is a natural stimulus for the orderly release of growth factors to support the body's natural healing process.

Biovance Human Amniotic Membrane

Biovance® Human Amniotic Membrane

Biovance®* Amniotic Membrane

CentaFlex decellularized human placental matrix allograft is derived from human umbilical cord and has the strength to support repair without the trade-off of overly thick tissue. Centaflex placental matrix serves as a cell-friendly structure to allow noninflammatory cell attachment, proliferation, and growth.
*CentaFlex™ is owed by Celularity Inc.

Wound Care

JumpStart^® Antimicrobial Wound Dressing

Interfyl^®*Connective Tissue Matrix

Biovance^®* Amniotic Membrane

CentaFlex™* Placental Matrix