Jason Wong

• MBChB FHEA PhD FRCS(Plast)
• Professor (Full) at The University of Manchester

The term 'fascia' has been applied to a large number of very different tissues within the hand. These range from aligned ligamentous formations such as the longitudinal bands of the palmar fascia or Grayson's and Cleland's ligaments, to the loose packing tissues that surround all of the moving structures within the hand. In other parts of the body...

Background: The use of pedicled perforator flaps provides an alternative to free tissue transfer for lower limb reconstruction. We use computer-aided image analysis to investigate the versatility of pedicled perforator flaps for the reconstruction of lower limb defects. Patients and methods: Between April 2007 and April 2011, a case series of 61...

Learning Objectives After reading this article, the participant should be able to: 1. Appreciate the variation and evolution of flexor tendon management 2. Know how to assess the patient who presents with a flexor tendon laceration. 3. Understand the biology of repairing flexor tendon lacerations. 4. Appreciate the technical challenges in flexor te...

Rationale: Vascular smooth muscle turnover has important implications for blood vessel repair and for the development of cardiovascular diseases, yet lack of specific transgenic animal models has prevented it's in vivo analysis. Objective: The objective of this study was to characterize the dynamics and mechanisms of vascular smooth muscle turno...

Arterial vasculature distributes blood from early embryonic development and provides a nutrient highway to maintain tissue viability. Atherosclerosis, peripheral artery diseases, stroke and aortic aneurysm represent the most frequent causes of death and are all directly related to abnormalities in the function of arteries. Vascular intervention tec...

Background and objectives Chronic skin wounds exhibit impaired re-epithelialisation due to defective keratinocyte migration and excessive inflammatory signals. Arginase1 (ARG1) is an enzyme expressed by keratinocytes that has been shown to be important for skin wound healing. However, the mechanisms underpinning keratinocyte ARG1 function in wound...

We present exact non-perturbative solutions to chiral gauge theories based on the $E_6$ gauge group and several matter fermions in the fundamental $\bf{27}$-dimensional representation. They are obtained when supersymmetric versions are perturbed by small supersymmetry breaking by anomaly mediation. The universality classes obtained are very differe...

This chapter explores the cutting-edge areas of tendon graft bioengineering, focusing on notable progress in biofabrication technologies, including 3D printing and electrospinning. These techniques facilitate the development of scaffolds that replicate the inherent architecture of tendons, offering the potential for enhanced repair results. The art...

We present exact results in $\text{SU}(N_C)$ chiral gauge theories with charged fermions in an antisymmetric, $N_F$ fundamental, and $N_C + N_F - 4$ anti-fundamental representations. We achieve this by considering the supersymmetric version of these theories and utilizing anomaly mediated supersymmetry breaking at a scale $m\ll\Lambda$ to generate...

Introduction The financial burden of wounds to healthcare systems continues to increase, with little progression on advanced treatment options. Single cell RNA sequencing studies have predominantly focused on phenotypically different cell types and are generally descriptive in their analyses. Coordination within the transcriptome can be modelled us...

Background and objectives Arginase1 (ARG1) is an enzyme expressed by keratinocytes that drives several functions linked to skin barrier function. However, the mechanisms underpinning keratinocyte ARG1 function in barrier homeostasis is not fully elucidated. Atopic dermatitis (AD) is linked to impaired skin barrier via altered keratinocyte different...

Collagen-I fibrillogenesis is crucial to health and development, where dysregulation is a hallmark of fibroproliferative diseases. Here, we show that collagen-I fibril assembly required a functional endocytic system that recycles collagen-I to assemble new fibrils. Endogenous collagen production was not required for fibrillogenesis if exogenous col...

Collagen-I fibrillogenesis is crucial to health and development, where dysregulation is a hallmark of fibroproliferative diseases. Here, we show that collagen-I fibril assembly required a functional endocytic system that recycles collagen-I to assemble new fibrils. Endogenous collagen production was not required for fibrillogenesis if exogenous col...

Introduction: The regional hand trauma service in Greater Manchester, United Kingdom, underwent significant reorganisation early in the COVID-19 pandemic, with a shift from predominantly general anaesthesia (GA) procedures to the adoption of a Wide-Awake Local Anaesthetic No Tourniquet (WALANT) technique. We implemented strategies targeted towards...

Introduction and aims Delayed cutaneous wound healing is a major problem that can result in social isolation and significant morbidity including amputation. There are many changes in cellular function in a chronic wound. Notably, the enzyme arginase (ARG)1 is markedly changed in wound healing. We have identified a role for ARG1 in keratinocyte re-e...

Collagen-I fibrillogenesis is crucial to health and development, where dysregulation is a hallmark of fibroproliferative diseases. Here, we show that collagen-I fibril assembly required a functional endocytic system that recycles collagen-I to assemble new fibrils. Endogenous collagen production was not required for fibrillogenesis if exogenous col...

The management of flexor tendon injury has seen many iterations over the years, but more substantial innovations in practice have been sadly lacking. The aim of this study was to investigate the current practice of flexor tendon injury management, and variation in practice from the previous reports, most troublesome complications, and whether there...

Collagen-I fibrillogenesis is crucial to health and development, where dysregulation is a hallmark of fibroproliferative diseases. Here, we show that collagen-I fibril assembly required a functional endocytic system that recycles collagen-I to assemble new fibrils. Endogenous collagen production was not required for fibrillogenesis if exogenous col...

Quantification of peripheral nerve regeneration after injury relies upon subjective outcome measures or electrophysiology assessments requiring fully regenerated neurons. Nerve surgeons and researchers lack objective, quantifiable information on the site of surgical repair and regenerative front. To address this need, we developed a quantifiable, v...

Introduction Flexor tendons are traditionally repaired under either general anaesthesia (GA) or regional anaesthesia (RA), allowing for the use of an arm tourniquet to minimise blood loss and establish a bloodless surgical field. However, the use of tourniquets exposes the patient to certain risks, including skin, muscle and nerve injuries. A recen...

Aim Colorectal anastomotic leak (AL) remains a significant challenge. The M-OMENTUM study compared omental-derived stromal-vascular cell-fraction (OSVCF) / alginate gel composite vs control subgroups to prevent murine AL. Methods C57BL-6 mice were subjected to an AL model with a leak rate (LR) of 40% and randomised (1:1) to OSVCF / alginate gel or...

Introduction: Movement is fundamental to the normal behaviour of the hand, not only for day-to-day activity, but also for fundamental processes like development, tissue homeostasis and repair. Controlled motion is a concept that hand therapists apply to their patients daily for functional gains, yet the scientific understanding of how this works i...

Unlabelled: Peripheral nerve injury (PNI) is a significant health problem that confers lifelong impact on those injured. Current interventions are purely surgical; however, outcomes remain poor. There is a lack of high-quality epidemiological data that is needed to identify populations involved, current healthcare demands, and ensure resources are...

Introduction: Ankle osteoarthritis (OA) in young patients is predominantly post-traumatic in etiology. Most nonsurgical treatments only provide transient relief of symptoms. Intraarticular injections of adipose tissue have successfully managed hip and knee OA. There is a single case report on using micro-fragmented adipose cell therapy in ankle OA....

Background: There are several possible interventions for managing pressure ulcers (sometimes referred to as pressure injuries), ranging from pressure-relieving measures, such as repositioning, to reconstructive surgery. The surgical approach is usually reserved for recalcitrant wounds (where the healing process has stalled, or the wound is not res...

Introduction: Post-traumatic subtalar joint arthritis is uncommon and the majority results as a consequence of either an intra-articular calcaneal or talar fracture. A unique case of management of subtalar joint arthritis is described using autologous microfragmented adipose cells therapy. Case Report: We presented a 48-year-old male with symptomat...

Introduction: Flexor tendon injuries of the hand and wrist involve complete or partial severance of the tendon, and primary repair is standard treatment. In cases of significantly delayed presentation, rupture of the repair or segmental tendon loss may require 1- or 2-stage secondary tendon reconstruction where a tendon graft is used. There is a r...

Background: Management of open fractures is challenging and requires a multidisciplinary team approach. This study aims to evaluate the outcomes of open Gustilo-Anderson IIIB fractures managed at a single Ortho-Plastic centre following One-stage “Fix and Flap” approach. Methods: Prospective data review for patients presenting with Gustilo-Anderson...

Citation Sawadkar, P., Wong, J., Mudera, V. A Novel Tenorrhaphy Suture Technique with Tissue Engineered Collagen Graft to Repair Large Tendon Defects. Abstract Surgical management of large tendon defects with tendon grafts is challenging, as there are a finite number of sites where donors can be readily identified and used. Currently, this gap is f...

Introduction: Recent experimental evidence suggests normothermic machine perfusion of the vascularized composite allograft results in improved preservation compared to static cold storage, with less reperfusion injury in the immediate post-operative period. However, metabolic acidosis is a common feature of vascularized composite allograft perfusi...

Non-healing wounds are a major area of unmet clinical need remaining problematic to treat. Improved understanding of pro-healing mechanisms is invaluable. The enzyme arginase1 is involved in pro-healing responses with its role in macrophages best characterized. Arginase1 is also expressed by keratinocytes; however, arginase1 function in these criti...

Arginase (ARG) represents an important evolutionarily conserved enzyme that is expressed by multiple cell types in the skin. Arg acts as the mediator of the last step of the urea cycle, thus providing protection against excessive ammonia under homeostatic conditions through the production of L-ornithine and urea. L-ornithine represents the intersec...

The field of hand surgery is constantly evolving to meet challenges of populations with increasing age and higher demands for active living. While our surgical care has improved over the last decades, it seems that future major improvement in outcomes of clinical treatment will come through advances in biologics and the translation of major discove...

Aim: Anastomotic leak is the most feared complication of gastrointestinal surgery. Mesenchymal stem cell technology is used clinically to promote wound healing, however the safety and efficacy of this technology on anastomotic healing has yet to be defined. To investigate whether mesenchymal stem cells confer any benefit when applied to animal mod...

Fabrication of the intricate anatomy of vasculature within engineered tissue remains one of the key challenges facing the field of tissue engineering. We report the use of electrohydrodynamic (EHD) inkjet printing to create hydrogel-based microvascular tissues with hierarchical and branching channels, whose minimum feature size of 30 μm approaches...

Introduction : The donor immune compartment plays a central role in graft rejection of the vascularised composite allograft (VCA) by contributing to ‘direct presentation’. Using our limb ex vivo normothermic machine perfusion (EVNP) protocol designed for prolonged allograft preservation, this study aimed to assess whether donor leukocytes responsib...

Collagen fibrils are the principal supporting elements in vertebrate tissues. They account for 25% of total protein mass, exhibit a broad range of size and organisation depending on tissue and stage of development, and can be under circadian clock control. Here we show that the remarkable dynamic pleomorphism of collagen fibrils is underpinned by a...

BACKGROUND Peripheral nerve injury (PNI) is common, leading to reduced function, pain, and psychological impact. Treatment has not progressed partly due to inability to compare outcomes between centers managing PNI. Numerous outcome measures exist but there is no consensus on which outcome measures to use nor when. OBJECTIVE To perform a systemati...

Purpose of Review Skin provides a window into the health of an individual. Using transplanted skin as a monitor can provide a powerful tool for surveillance of rejection in a transplant. The purpose of this review is to provide relevant background to the role of skin in vascularized transplantation medicine. Recent Findings Discrete populations of...

The repair of tendon injuries is often compromised by post-operative peritendinous adhesions. Placing a physical barrier at the interface between the tendon and the surrounding tissue could potentially solve this problem by reducing adhesion formation. At present, no such system is available for routine use in clinical practice. Here, we propose th...

Survival rates of digital replantation vary in different regions and countries, and Asian surgeons see more challenging cases and have developed some unique methods. Replantation of multiple digits in one or both hands can follow a structure-by-structure method or a digit-by-digit method. For replanting all 10 digits, 3 or 4 teams should be organiz...

Background Attempts to improve limb preservation for transplantation using ex vivo perfusion have yielded promising results. However, metabolic acidosis, aberrant perfusate biochemistry and significant perfusion‐induced oedema are reported universally. Optimizing perfusion protocols is therefore essential for maintaining tissue health. Methods A r...

Background: Numerous studies have documented the in vitro differentiation of human pluripotent stem cells (hPSCs) into kidney cells. Fewer studies have followed the fates of such kidney precursor cells (KPCs) inside animals, a more life-like setting. Here, we tested the hypothesis that implanting hPSC-derived KPCs into an in vivo milieu surgically...

Background This study aims to evaluate outcomes of using Adjuvant Local Antibiotic Hydroxyapatite Bio-Composite in management of Open Gustilo-Anderson IIIB Fractures. Methods and results 80 patients were managed with single-stage “Fix and Flap” along with intra-operative Adjuvant Local Antibiotic Bio-Composite. Successful fracture union was achiev...

Plastic surgery encompasses a broad spectrum of reconstructive challenges and prides itself upon developing and adopting new innovations. Practice has transitioned from microsurgery to supermicrosurgery with a possible future role in even smaller surgical frontiers. Exploiting materials on a nanoscale has enabled better visualization and enhancemen...

Background: Mid-foot open fractures are rare, and usually presents with high energy trauma. Staged approach for the management of open midfoot fractures was described by few authors. Case presentation: Up to authors best knowledge, this is the first article describing the management of mid-foot open fracture that presented 6 weeks post injury and h...

The rapid vascularisation of biomaterials and artificial tissues is a key determinant for their in vivo viability and ultimately for their integration in a host; therefore promoting angiogenesis and maintaining the newly formed vascular beds has become a major goal of tissue engineering. The arteriovenous loop (AVL) has been an extensively studied...

Background: Peripheral nerve injuries are common, with approximately 9,000 cases in the UK annually. Young working individuals are predominantly affected, leading to significant health and social implications. Functional recovery is often poor with impaired hand sensation, reduced motor function and pain and cold intolerance. Where a nerve gap exis...

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Timely, recent developments in X-ray micro-computed tomography (XµCT) imaging such as increased resolution and improved sample preparation are enabling non-destructive time lapse imaging of polymeric biomaterials when implanted in soft tissue, which we demonstrate herein. Imaging the full 3D structure of an implanted biomaterial provides new opport...

Background: Venous leg ulcers (VLUs) are a common type of complex wound that have a negative impact on people's lives and incur high costs for health services and society. It has been suggested that prolonged high levels of protease activity in the later stages of the healing of chronic wounds may be associated with delayed healing. Protease modul...

Surgical management of large tendon defects with tendon grafts is challenging, as there are a finite number of sites where donors can be readily identified and used. Currently, this gap is filled with tendon auto-, allo-, xeno-, or artificial grafts, but clinical methods to secure them are not necessarily translatable to animals because of the scal...

Surgical robots have the potential to provide surgeons with increased capabilities, such as removing physiologic tremor, scaling motion and increasing manual dexterity. Several surgical specialties have subsequently integrated robotic surgery into common clinical practice. Plastic and reconstructive microsurgical procedures have not yet benefitted...

Pentalogy of Cantrell (PC) is a rare multi-organ congenital anomaly that impedes ventral body wall closure and results in diaphragmatic hernia, intra- and pericardial defects. The underlying cellular and molecular changes that lead to these severe developmental defects have remained unknown largely due to the lack of representative animal models. H...

Background: Chronic osteomyelitis necessities appropriate infected bone and soft tissue excision. The authors describe the Silo surgical technique for the treatment of calcaneal osteomyelitis using a new antibiotic-loaded absorbable calcium sulphate/hydroxyapatite biocomposite. Methods: The Silo method involves debridement of the dead bone and l...

Background: Passenger leucocytes and inflammatory debris transferred from the donor limb to the recipient can induce allorecognition, which activates the host immune response. This is the first study to evaluate whether the transfer of this inflammatory burden can be reduced via post-preservation flush prior to revascularisation, and whether this...

This is a protocol for a Cochrane Review (Prognosis). The objectives are as follows: To determine whether protease activity is an independent prognostic factor for the healing of venous leg ulcers.

An important and often underinvestigated contributor to solid organ transplant rejection is ischemia reperfusion injury. This pathophysiological response releases damaging reactive oxygen species and cell stress signals that initiate inflammation, which has a critical role in priming the immune system for allorecognition. In time, this renders graf...

Ventral body wall (VBW) defects are among the most common congenital malformations, yet their embryonic origin and underlying molecular mechanisms have remained poorly characterized. Although transforming growth factor beta (TGF-β) signalling is essential for VBW closure the responding cells are not known. Here we identify a population of migratory...

Background: Surgical site infection rates in the month following surgery vary from 1% to 5%. Due to the large number of surgical procedures conducted annually, the costs of these surgical site infections (SSIs) can be considerable in financial and social terms. Nasal decontamination using antibiotics or antiseptics is performed to reduce the risk...

The use of local anaesthesia and adrenaline for hand surgery is gaining popularity; however, where vascularity is impaired, wide-awake surgery is considered a contraindication. We present our case series of five digital devascularizations and eight amputations that underwent surgery using the 'wide-awake' anaesthetic technique. A temporary digital...

Survival rates of digital replantation vary in different regions and countries, and Asian surgeons see more challenging cases and have developed some unique methods. Replantation of multiple digits in one or both hands can follow a structure-by-structure method or a digit-by-digit method. For replanting all 10 digits, 3 or 4 teams should be organiz...

Background: The management of pressure ulcers involves several interventions ranging from pressure-relieving measures such as repositioning, to treatments that can include reconstructive surgery. Such surgery may be considered for recalcitrant wounds when full thickness skin loss arises and deeper structures such as muscle fascia and even bone are...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of nasal decontamination on preventing surgical site infections (SSIs) in people who are S aureus carriers undergoing surgery, treated in any setting. © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

The continuing enhancement of the surgical environment in the digital age has led to a number of innovations being highlighted as potential disruptive technologies in the surgical workplace. Augmented reality (AR) and virtual reality (VR) are rapidly becoming increasingly available, accessible and importantly affordable, hence their application int...

Background: Many techniques have been described to relieve the compression and reduce subluxation of the ulnar nerve following surgery. The subfascial anterior transposition of the ulnar nerve (SfATUN) is one described technique, but involves a long scar, risk of injury to the medial antebrachial cutaneous nerve, and possible nerve ischemia from a...

The functional replacement of tendon represents an unmet clinical need in situations of tendon rupture, tendon grafting and complex tendon reconstruction, as usually there is a finite source of healthy tendon to use as donors. The micro fibrous architecture of tendon is critical to the function of tendon. This study investigates the use of electros...

Background: The radiographic and clinical outcomes following vascularized bone grafting (VBG) for scaphoid nonunion have previously been reported in the literature; however, few studies report on patient-derived outcomes. The purpose of this study was to determine the effect of VBG for scaphoid nonunion on patient-derived outcomes.Methods:The MEDLI...

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of reconstructive surgery to close pressure ulcer wounds compared with no surgery or alternative forms of reconstructive surgery on the healing of pressure ulcers (category/stage 2 or above) in any care setting. © 2016 The Cochrane Colla...

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