Andrew J Watt

California Pacific Medical Center Research Institute, San Francisco, California, United States

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Publications (23)42.88 Total impact

  • Andrew J Watt · Randal P Ching · Jerry I Huang ·
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    ABSTRACT: Complications in metacarpal fracture treatment increase in proportion to the severity of the initial injury and the invasiveness of the surgical fixation technique. This manuscript evaluates the feasibility of minimizing internal fixation construct size and soft tissue dissection, while preserving the advantages of stable internal fixation in a biomechanical model. We hypothesized that comparable construct stability could be achieved with mini-plates in an orthogonal (90/90) configuration compared with a standard dorsal plating technique. This hypothesis was evaluated in a transverse metacarpal fracture model. Twelve metacarpals were subject to either placement of a 2.0-mm six-hole dorsal plate or two 1.5-mm four-hole mini-plates in a 90/90 configuration. These constructs were tested to failure in a three-point bending apparatus, attaining failure force, displacement, and stiffness. Mean failure force was 353.5 ± 121.1 N for the dorsal plating construct and 358.8 ± 77.1 N for the orthogonal construct. Mean failure displacement was 3.3 ± 1.2 mm for the dorsal plating construct and 4.1 ± 0.9 mm for the orthogonal construct. Mean stiffness was 161.3 ± 50.0 N/mm for the dorsal plating construct and 122.1 ± 46.6 N/mm for the orthogonal construct. Mean failure moment was 3.09 ± 1.06 Nm for the dorsal plating construct and 3.14 ± 0.67 Nm for the orthogonal construct. The dorsal plating group failed via screw pullout, whereas the orthogonal failed either by screw pullout or breakage of the plate. When subject to apex dorsal bending, the orthogonal construct and the standard dorsal plate construct behaved comparably. These data suggest that despite its shorter length, lower profile, and less substantial screws, the orthogonal construct provides sufficient rigidity. This study represents a "proof of concept" regarding the applicability of orthogonal plating in the metacarpal and provides the foundation for minimizing construct size and profile.
    Hand 03/2015; 10(1):94-99. DOI:10.1007/s11552-014-9673-3
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    ABSTRACT: Purpose To compare the efficacy, tolerance, and safety of manual manipulation at day 7 to day 1 following collagenase Clostridium histolyticum (CCH) injection for Dupuytren contracture. Methods Eligible patients were randomized to manipulation at day 1 versus day 7 following CCH injection. Preinjection, premanipulation, postmanipulation, and 30-day follow-up metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint contractures were measured. Pain scores were recorded at each time point. Data were stratified per cohort based on primary joint treated (MCP vs PIP). Means were compared using paired and unpaired t-tests. Results Forty-three patients with 46 digits were eligible and were randomized to 1-day (22 digits) and 7-day (24 digits) manipulation. For MCP joints, there were no significant differences in flexion contractures between 1- and 7-day cohorts for initial (47° vs 46°), postmanipulation (0° vs 2°), or 30-day follow-up (1° vs 2°) measurements. Premanipulation, the residual contracture was significantly lower in the 7-day group (23° vs 40°). For PIP joints, there were no significant differences between 1- and 7-day cohorts for initial (63° vs 62°), premanipulation (56° vs 52°), postmanipulation (13° vs 15°), or 30-day (14° vs 16°) measurements. There were no significant differences in pain or skin tears between the 2 groups. No flexor tendon ruptures were observed. Conclusions The effectiveness of CCH in achieving correction of Dupuytren contractures was preserved when manipulation was performed on day 7, with no differences in correction, pain, or skin tears. These data suggest that manipulation can be scheduled at the convenience of the patient and surgeon within the first 7 days after injection. Type of study/level of evidence Therapeutic I.
    Plastic &amp Reconstructive Surgery 10/2014; 39(10). DOI:10.1016/j.jhsa.2014.07.010 · 2.99 Impact Factor
  • Andrew J. Watt · Kevin C. Chung ·
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    ABSTRACT: Surgical approaches to the hand are commonly executed in the treatment of fractures, ligament injuries, and less commonly in the resection of bony tumors. Careful design and execution of these surgical approaches translates into superior functional and aesthetic outcomes. We have provided a thorough review of commonly used approaches to the hand by evaluating each of these approaches in the context of core principles including safety, versatility, preservation of stability, and aesthetic outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.
    Hand Clinics 09/2014; 30(4). DOI:10.1016/j.hcl.2014.07.004 · 1.26 Impact Factor
  • Article: In Reply.
    Jordan W Swanson · Andrew J Watt · Nicholas B Vedder ·

    The Journal of hand surgery 06/2013; 38(6):1264-1265. DOI:10.1016/j.jhsa.2013.04.014 · 1.67 Impact Factor
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    ABSTRACT: The transverse tensor fascia lata (TTFL) flap is an important alternative flap for autologous breast reconstruction. It is a horizontal variant of the tensor fascia lata myocutaneous flap and contains fat from the prominence of the upper lateral thigh (saddle bag). We present the surgical management of a woman with trochanteric lipodystrophy, who underwent staged bilateral mastectomy and autologous breast reconstruction with TTFL flaps. We discuss technical points in TTFL flap design and harvest. Breast reconstruction was successful and the thigh donor sites had excellent aesthetic contour. There were no complications at either recipient or donor sites. The TTFL flap is an important alternative flap for autologous breast reconstruction when other options are less optimal, and has a secondary benefit of thigh donor site closure with lateral thigh lift techniques. The TTFL flap should be presented as an option for autologous breast reconstruction in women with prominent trochanteric lipodystrophy of the upper lateral thighs.
    Annals of plastic surgery 03/2013; 70(4). DOI:10.1097/SAP.0b013e31828a0c80 · 1.49 Impact Factor
  • Jordan W Swanson · Andrew J Watt · Nicholas B Vedder ·
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    ABSTRACT: Treatment of Dupuytren disease with collagenase clostridium histolyticum is increasingly used among hand surgeons. Although it is generally safe and efficacious, complications related to enzymatic fasciotomy occur. Postapproval surveillance and communication among hand surgeons continues to refine the indications, contraindications, and complications recognized in the treatment of Dupuytren disease with enzymatic therapy. Major treatment-related adverse events previously reported include flexor tendon rupture and complex regional pain syndrome. We report a patient who experienced total loss of a well-established volar ring finger skin graft following collagenase injection and propose a potential mechanism of vulnerability. This case may illustrate the susceptibility of type I collagen, which is uniformly present in a healed skin graft bed, to degradation with collagenase. We propose a cautious approach when considering treatment of a Dupuytren cord with collagenase in the presence of an overlying skin graft, regardless of the age of the graft.
    The Journal of hand surgery 02/2013; 38A(3). DOI:10.1016/j.jhsa.2012.12.007 · 1.67 Impact Factor
  • Joseph N Carey · Clifford C Sheckter · Andrew J Watt · Gordon K Lee ·
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    ABSTRACT: Despite advances in nutritional supplementation, sepsis management, percutaneous drainage and surgical technique, enterocutaneous fistulae remain a considerable source of morbidity and mortality. Use of adjunctive modalities including negative pressure wound therapy and fibrin glue have been shown to improve the rapidity of fistula closure; however, the overall rate of closure remains poor. The challenge of managing chronic, high-output proximal enterocutaneous fistulae can be successfully achieved with appropriate medical management and intra-abdominal placement of pedicled rectus abdominis muscle flaps. We report two cases of recalcitrant high output enterocutaneous fistulae that were treated successfully with pedicled intra-abdominal rectus muscle flaps. Indications for pedicled intra-abdominal rectus muscle flaps include persistent patency despite a reasonable trial of non-operative intervention, failure of traditional operative interventions (serosal patch, Graham patch), and persistent electrolyte and nutritional abnormalities in the setting of a high-output fistula.
    Journal of Plastic Reconstructive & Aesthetic Surgery 01/2013; 66(8). DOI:10.1016/j.bjps.2012.12.008 · 1.42 Impact Factor
  • Andrew J Watt · Jeffrey B Friedrich · Jerry I Huang ·
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    ABSTRACT: Surgeons and scientists have been developing alternative methods of hand reconstruction that may play an adjunctive role to, or completely supplant, more traditional reconstructive modalities. This article provides an overview of these emerging techniques, with an emphasis on skin substitutes and negative-pressure wound therapy as they apply to the treatment of soft tissue defects of the hand. The indications, contraindications, and relative advantages and disadvantages of these techniques are discussed in detail.
    Hand clinics 11/2012; 28(4):519-28. DOI:10.1016/j.hcl.2012.08.010 · 1.26 Impact Factor
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    ABSTRACT: Dupuytren disease (DD) is a benign, generally painless connective tissue disorder affecting the palmar fascia that leads to progressive hand contractures. Mediated by myofibroblasts, the disease most commonly begins as a nodule in the palm or finger, and can progress where pathologic cords form leading to progressive flexion deformity of the involved fingers. The palmar skin overlying the cords may become excessively calloused and contracted and involved joints may develop periarticular fibrosis. Although there is no cure, the sequellae of this affliction can be corrected. This article focuses on the role of collagen in DD and the development of a collagen-specific enzymatic treatment for DD contractures.
    Hand clinics 11/2012; 28(4):551-63. DOI:10.1016/j.hcl.2012.08.003 · 1.26 Impact Factor
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    ABSTRACT: In the elderly population with significant medical comorbidities, the safety of general anesthesia is often in question. In the head and neck, where regional and extradural anesthesia are not options, reconstruction of defects requiring free tissue transfer becomes a particular challenge for patients in whom general anesthesia is contraindicated. We present a case of a scalp reconstruction utilizing a latissimus dorsi free flap in a 91-year-old man performed entirely under local and regional anesthesia. General anesthesia was contraindicated secondary to the patient's multiple medical comorbidities. A paravertebral block was used for the harvest of the latissimus dorsi muscle and skin grafts. The microvascular portion of the procedure and the inset were performed under local anesthesia alone. The patient tolerated the procedure, and the operation was successful. This case is unique in that there are no published reports of head and neck free tissue transfer being performed entirely under local-regional anesthesia. We conclude that despite the medical challenges of performing complex reconstruction in elderly patients, expedient free tissue transfer can offer patients access to successful reconstruction.
    Journal of Reconstructive Microsurgery 01/2012; 28(3):189-93. DOI:10.1055/s-0031-1301070 · 1.31 Impact Factor
  • Andrew J Watt · James Chang ·
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    ABSTRACT: Proper hand function relies on a combination of strength and mobility. The intricate architecture that allows for hand mobility includes the articular surfaces of joints, periarticular ligamentous structures, tendon mechanisms, and the soft-tissue envelope. These structures are subject to injury and scarring. The net effect of a variety of etiologic factors is stiffness of the hand with diminution of hand function. This article reviews the biology of healing, pertinent anatomy of the hand, and operative and nonoperative treatment of the stiff hand.
    Clinics in plastic surgery 10/2011; 38(4):577-89. DOI:10.1016/j.cps.2011.07.006 · 0.91 Impact Factor
  • Andrew J Watt · Vincent R Hentz ·
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    ABSTRACT: Collagenase clostridium histolyticum has demonstrated safety and efficacy in the treatment of metacarpophalangeal and proximal interphalangeal joint contractures in Dupuytren's disease as a 0.58-mg dose delivered via direct injection into the Dupuytren's cord. Extension is achieved via manual manipulation 24 h following injection. Commercially available collagenase clostridium histolyticum is a combination of class I and class II collagenases that act in concert to degrade the type I and type III collagen content of pathologic Dupuytren's cords and is available to practitioners who have completed focused training in injection technique. This article reviews collagenase clostridium histolyticum pharmacodynamics as well as the basic science and clinical studies resulting in US FDA and EMA approval for the treatment of Dupuytren's disease. Clinical indications, technique and an analysis of future indications are reviewed.
    04/2011; 6(2):123-133. DOI:10.2217/ijr.11.4
  • Andrew J Watt · Alexander Y Shin · Nicholas B Vedder · James Chang ·
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    ABSTRACT: Learning Objectives: After reviewing this article, the participant should be able to: 1. Recognize and treat common hand infections. 2. Define the pathophysiology and appropriately manage high-pressure injection injuries. 3. Define the operative indications for treatment of Dupuytren disease. 4. Understand the role of operative treatment in rheumatoid arthritis and osteoarthritis. Summary: The hand, by virtue of its position in space, complex anatomical composition, and characteristic biomechanical properties, is subject to a host of disease processes and traumatic injuries. This article reviews the presentation, evaluation, treatment, and outcomes of treatment in hand infections, high-pressure injection injuries, Dupuytren disease, and arthritis. (Plast. Reconstr. Surg. 126: 288e, 2010.)
    Plastic and Reconstructive Surgery 12/2010; 126(6):288e-300e. DOI:10.1097/PRS.0b013e3181f44873 · 2.99 Impact Factor
  • Andrew J Watt · Catherine M Curtin · Vincent R Hentz ·
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    ABSTRACT: Collagenase has been investigated in phase II and phase III clinical trials for the treatment of Dupuytren's disease. The purpose of this study is to report 8-year follow-up results in a subset of patients who had collagenase injection for the treatment of Dupuytren's contracture. Twenty-three patients who participated in the phase II clinical trial of injectable collagenase were contacted by letter and phone. Eight patients were enrolled, completed a Dupuytren's disease questionnaire, and had independent examination of joint motion by a single examiner. Eight patients completed the 8-year follow-up study: 6 had been treated for isolated metacarpophalangeal (MCP) joint contracture, and 2 had been treated for isolated proximal interphalangeal (PIP) joint contracture. Average preinjection contracture was 57 degrees in the MCP group. Average contracture was 9 degrees at 1 week, 11 degrees at 1 year, and 23 degrees at 8-year follow-up. Four of 6 patients experienced recurrence, and 2 of 6 had no evidence of disease recurrence at 8-year follow-up. Average preinjection contracture was 45 degrees in the PIP group. Average contracture was 8 degrees at 1 weeks, 15 degrees at 1 year, and 60 degrees at 8-year follow-up. Both patients experienced recurrence at 8-year follow-up. No patients had had further intervention on the treated finger in either the MCP or the PIP group. Patients subjectively rated the overall clinical success at 60%, and 88% of patients stated that they would pursue further injection for the treatment of their recurrent or progressive Dupuytren's disease. Enzymatic fasciotomy is safe and efficacious, with initial response to injection resulting in reduction of joint contracture to within 0 degrees -5 degrees of normal in 72 out of 80 patients. Initial evaluation of long-term recurrence rates suggests disease recurrence or progression in 4 out of 6 patients with MCP contractures and 2 patients with PIP contractures; however, recurrence was generally less severe than the initial contracture in the MCP group. In addition, patient satisfaction was high.
    The Journal of hand surgery 04/2010; 35(4):534-9, 539.e1. DOI:10.1016/j.jhsa.2010.01.003 · 1.67 Impact Factor
  • Article: Duplication
    Andrew J Watt · Kevin C Chung ·
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    ABSTRACT: Congenital limb duplications include pre- and post-axial polydactyly, central polydactyly, and the mirror-hand spectrum. Treatment of these duplications constitutes a significant functional and aesthetic challenge for the reconstructive hand surgeon. This article provides an inclusive review of the embryologic and molecular mechanisms underlying these deformities and focuses on their clinical treatment. The anatomic variation, classification, surgical treatment, and outcomes of surgical intervention are reviewed for each of the disorders of duplication.
    Hand clinics 06/2009; 25(2):215-27. DOI:10.1016/j.hcl.2009.01.001 · 1.26 Impact Factor
  • Andrew J Watt · Kevin C Chung ·
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    ABSTRACT: Given the complexity and diversity of congenital differences, a separate and broad category of generalized skeletal abnormalities was proposed to include all conditions that are unable to be neatly packaged into the other categories. Some of the conditions included in this category are obscure, whereas others are more common. Some conditions listed in this section may fit into other categories but may be considered as part of the overall classification scheme. This article presents congenital trigger finger, congenital clasped thumb, Madelung's deformity, and other skeletal hand deformities that are characteristic of generalized bone and connective tissue disorders, including achondroplasia and Marfan syndrome.
    Hand clinics 06/2009; 25(2):265-76. DOI:10.1016/j.hcl.2008.12.008 · 1.26 Impact Factor
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    ABSTRACT: Erb's palsy is well known to physicians across medical specialties, and its clinical manifestations present a formidable challenge to reconstructive surgeons. Although the condition is well established, knowledge pertaining to its namesake, Wilhelm Heinrich Erb, is rather obscure in the existing scientific literature. Erb was influential not only through his description of classic brachial plexus palsy involving the superior (or upper) roots, but also by his indelible contributions to our understanding of peripheral nerve physiology, deep tendon reflexes, and the muscular dystrophies. Erb's contributions to medicine transcend specialty boundaries. In this article, the authors seek to convey his scientific achievements and the character of the man through translation of his German manuscripts. These texts, complemented by the existing English literature, provide a unique perspective on Wilhelm Heinrich Erb's contribution to medicine. The authors will also emphasize his role in describing and clarifying the nature of Erb's palsy.
    Plastic and Reconstructive Surgery 07/2007; 119(7):2161-6. DOI:10.1097/01.prs.0000260726.74745.b8 · 2.99 Impact Factor
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    ABSTRACT: The best treatment for an inadequately reduced fracture of the distal part of the radius is not well established. We collected prospective outcomes data for patients undergoing open reduction and internal fixation of an inadequately reduced distal radial fracture with use of the volar locking plating system. Over a two-year period, 161 patients underwent open reduction and internal fixation of an inadequately reduced distal radial fracture with use of the volar locking plating system. Patients were enrolled in the present study three months after the fracture on the basis of strict entry criteria and were evaluated three, six, and twelve months after surgery. Outcome measures included radiographic parameters, grip strength, lateral pinch strength, the Jebsen-Taylor test, wrist range of motion, and the Michigan Hand Outcomes Questionnaire. Eighty-seven patients with a distal radial fracture were enrolled. The mean age at the time of enrollment was 48.9 years. Forty percent (thirty-five) of the eighty-seven fractures were classified as AO type A, 9% (eight) were classified as type B, and 51% (forty-four) were classified as type C. Radiographic assessment showed that the plating system maintained anatomic reduction at the follow-up periods. At the time of the twelve-month follow-up, the mean grip strength on the injured side was worse than that on the contralateral side (18 compared with 21 kg; p<0.01), the mean pinch strength on the injured side was not significantly different from that on the contralateral side (8.7 compared with 8.9 kg; p=0.27), and the mean flexion of the wrist on the injured side was 86% of that on the contralateral side. All Michigan Hand Outcomes Questionnaire domains approached normal scores at six months, with small continued improvement to one year. The volar locking plating system appears to provide effective fixation when used for the treatment of initially inadequately reduced distal radial fractures.
    The Journal of Bone and Joint Surgery 12/2006; 88(12):2687-94. DOI:10.2106/JBJS.E.01298 · 5.28 Impact Factor
  • Kevin C Chung · Andrew J Watt · Sandra V Kotsis ·
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    ABSTRACT: Scapholunate advanced collapse wrist deformity is a common pattern of degenerative arthrosis of the wrist. This study prospectively evaluated a series of patients who underwent four-corner fusion using a circular plate internal fixation technique. Patients with symptomatic stage II scapholunate advanced collapse wrist deformity were treated with scaphoid excision and four-corner fusion using the Spider Limited Wrist Fusion Plate (KMI, San Diego, Calif.). Patients were prospectively evaluated at 6 months and 1 year using a standard study protocol with radiographs, functional tests, and an outcomes questionnaire. Outcomes were compared with those of historical series from the literature. Eleven patients were enrolled and 10 patients completed their 1-year follow-up. Grip strength, lateral pinch strength, and Jebsen-Taylor test scores at 1 year were not significantly different from preoperative values. Mean active range of motion was 87 degrees preoperatively and 74 degrees at 1-year follow-up (p = 0.19). The Michigan Hand Outcomes Questionnaire showed no significant improvement in function, activities of daily living, work, pain, or patient satisfaction. The mean pain scores decreased from 54 preoperatively to 42 1-year postoperatively (p = 0.30), indicating persistent wrist discomfort. Three patients had broken screws: one was asymptomatic, one required 3 months of strict wrist immobilization, and one was reoperated for symptomatic nonunion. Four-corner fusion using the first-generation Spider plate technique has the advantage of earlier mobility and more patient comfort from absence of protruding Kirschner wires; however, patients continued to have disabling pain, functional limitations, work impairment, and low satisfaction scores postoperatively. Although limited by a small patient sample, this series presents outcomes data that may be useful in counseling patients who are contemplating four-corner fusion using this internal fixation device. Further investigation is necessary to evaluate the biomechanical properties of the Spider plate. The data suggest that better implants should be designed to avoid implant failure, which occurred in three of the 11 patients in this series.
    Plastic and Reconstructive Surgery 09/2006; 118(2):433-42. DOI:10.1097/01.prs.0000227737.90007.5d · 2.99 Impact Factor
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    ABSTRACT: Parathyroid hormone (PTH) regulation of matrix metalloproteinase-13 (MMP-13) expression in osteoblasts contributes to normal bone turnover. The PTH response region of the rat MMP-13 gene spans nucleotides (nt) -148 to -38 and supports binding of numerous transcription factors, including Runx2, necessary for osteoblast differentiation, c-Fos/c-Jun, and Ets-1. These trans-acting proteins mediate hormone induction via incompletely defined combinatorial interactions. Within this region, adjacent to the distal Runx2 site, is a homopolymeric(dA:dT) element (-119/-110 nt) that conforms to the consensus site for the novel transcription factor nuclear matrix protein-4/cas interacting zinc finger protein (Nmp4/CIZ). This protein regulates bone cell expression of type I collagen and suppresses BMP2-enhanced osteoblast differentiation. The aim of this study was to determine whether Nmp4/CIZ contributes to MMP-13 basal transcription and PTH responsiveness in osteoblasts. Electrophoretic mobility shift analysis confirms Nmp4/CIZ binding within the MMP-13 PTH response region. Mutation of the Nmp4/CIZ element decreases basal activity of an MMP-13 promoter-reporter construct containing the first 1329 nt of the 5'-regulatory region, and overexpression of Nmp4/CIZ protein enhances the activity of the wild-type promoter. The same mutation of the homopolymeric(dA:dT) element enhances the MMP-13 response to PTH and PGE(2). Overexpression of Nmp4/CIZ diminishes hormone induction. Mutation of both the homopolymeric(dA:dT) element and the adjacent Runx2 site further augments the PTH response. On the basis of these data and previous studies, we propose that Nmp4/CIZ is a component of a multiprotein assemblage or enhanceosome within the MMP-13 PTH response region and that, within this context, Nmp4/CIZ promotes both basal expression and hormonal synergy.
    AJP Endocrinology and Metabolism 09/2004; 287(2):E289-96. DOI:10.1152/ajpendo.00517.2003 · 3.79 Impact Factor

Publication Stats

418 Citations
42.88 Total Impact Points


  • 2015
    • California Pacific Medical Center Research Institute
      San Francisco, California, United States
  • 2012-2014
    • University of Washington Seattle
      • Department of Orthopaedics and Sports Medicine
      Seattle, Washington, United States
  • 2009-2014
    • Stanford University
      • • Department of Surgery
      • • Division of Plastic and Reconstructive Surgery
      Stanford, California, United States
  • 2004
    • Robert Wood Johnson University Hospital
      New Brunswick, New Jersey, United States
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States