A new approach to the problem of flexor tendon repair within the fibro-osseous canal is presented.
Using a technique of bevelling the tendon ends and suturing with a fine suture material, under magnification, a sufficiently strong junction is obtained, which enables immediate active mobilisation without strangulation of the blood supply. The junction can resist gap formation up to tensions of 4 Kg.
It is postulated that under these conditions tendon nutrition is minimally interfered with, adhesions do not form, and the tendon heals by its own intrinsic healing ability.
Get full access to this article
View all access options for this article.
References
1.
BECKERH., & DAVIDOFFM. R. (1977) The Physical Properties of Suture Materials as Related to Knot Holding. South African Journal of Surgery, 15: 105–113.
2.
BERGLJUNGL. (1970) Vascular Reactions in Tendon Healing. Stereomicroangiographic Studies of Tendon Suturing Techniques and Tendon Transplantation. Angiology, 21: 375–384.
3.
BIRDSELLD. C., TUSTANOFFE. R., & LINDSAYW. K. (1966) Collagen Productior. in Regenerating Tendon. Plastic and Reconstructive Surgery, 37: 504–511.
4.
BRUNIUSU. (1968) Wound Healing Impairment from Sutures. A Tensiometric and Histologic Study in the Rat. Acta Chirurgica Scandinavica Supplementum, 395.
5.
BRUNIUSU., & AHRÉNC. (1969) Healing of Skin Incisions During Reduced Tension of the Wound Area. A Tensiometric and Histologic Study in the Rat. Acta Chirurgica Scandinavica, 135: 383–390.
6.
BRUNIUSU., & ZEDERFELDTB. (1965) Effects of Anti-inflammatory Treatment on Wound Healing. Acta Chirurgica Scandinavica, 129: 462–467.
7.
BUNTINGC. H., & EADESC. C. (1926) The Effect of Mechanical Tension upon the Polarity of Growing Fibroblasts. The Journal of Experimental Medicine, 44: 147–149.
8.
CAPLANH. S., HUNTERJ. M., & MERKLINR. J. (1975) Intrinsic Vascularisation of Flexor Tendons. Symposium on Tendon Surgery in the Hand. American Academy of Orthopaedic Surgeons. Saint Louis, The C. V. Mosby Company. 48–58.
9.
FURLOWL. T.Jr. (1976) the Role of Tendon Tissues in Tendon Healing. Plastic and Reconstructive Surgery, 57: 39–49.
10.
KESSLERI., & NISSIMF. (1969) Primary Repair Without Immobilisation of Flexor Tendon Division Within the Digital Sheath. An Experimental and Clinical Study. Acta Orthopaedica Scandinavica, 40: 587–601.
11.
KETCHUML. D. (1971) Effects of Triamcinolone on Tendon Healing and Function. A Laboratory Study. Plastic and Reconstructive Surgery, 47: 471–482.
12.
KLEINERTH. E., FORSHEWF. C., & COHENM. J. (1975) Repair of zone 1 flexor tendon injuries. American Academy of Orthopaedic Surgeons. Symposium on Tendon Surgery in the Hand. Saint Louis. The C. V. Mosby Company, 115–122.
13.
KLEINERTH. E., KUTZJ. E., ATASOYE., & STORMOA. (1973) Primary Repair of Flexor Tendons. Orthopedic-Clinics of North America, 4: 865–876.
14.
LINDSAYW. K., & THOMPSONH. G. (1960) Digital Flexor Tendons: An Experimental Study. Part I. The Significance of Each Component of the Flexor Mechanism in Tendon Healing. British Journal of Plastic Surgery, 12: 289–316.
15.
LINDSAYW. K., THOMPSONH. G., & WALKERF. G. (1960) Digital Flexor Tendons: An Experimental Study. Part II. The Significance of a Gap Occuring at the Line of Suture. British Journal of Plastic Surgery, 13: 1–9.
16.
LUNDBORGG. (1975) The Microcirculation in the Rabbit Tendon. In Vivo Studies after Mobilisation and Transection. The Hand, 7: 1–10.
17.
LUNDBORGG. (1976) Experimental Flexor Tendon Healing without Adhesion Formation - A New Concept of Tendon Nutrition and Intrinsic Healing Mechanisms. The Hand, 8: 235–238.
18.
MASONM. L., & ALLENH. S. (1941) The Rate of Healing of Tendons. An Experimental Study of Tensile Strength. Annals of Surgery, 113: 424–459.
19.
MATTHEWSP. (1976) The Fate of Isolated Segments of Flexor Tendons within the Digital Sheath - A Study in Synovial Nutrition. British Journal of Plastic Surgery79: 216–224.
20.
MATTHEWSP., & RICHARDSH. (1974) The Repair Potential of Digital Flexor Tendons. An Experimental Study. The Journal of Bone and Joint Surgery, 56B: 618–625.
21.
McDOWELLC. L., & SNYDERD. M. (1977) Tendon healing: An experimental model in the dog. The Journal of Hand Surgery, 2: 122–126.
22.
PEACOCKE. E. (1965) Biological Principles in the Healing of Long Tendons. Surgical Clinics of North America, 45: 461–476.
23.
PEACOCKE. E. (1964) Fundamental Aspects of Wound Healing Relating to the Restoration of Gliding Function after Tendon Repair. Surgery Gynecology and Obstetrics, 119: 241–250.
24.
POTENZAA. D. (1962) Tendon Healing Within the Flexor Digital Sheath in the Dog. An Experimental Study. The Journal of Bone and Joint Surgery, 44A: 49–64.
25.
POTENZAA. D. (1963) Critical Evaluation of Flexor Tendon Healing and Adhesion Formation within Artificial Digital Sheaths. Journal of Bone and Joint Surgery, 45A: 1217–1233.
26.
REYNOLDSB., WRAYR. C. JNR., & WEEKSP. M. (1976) Should an Incompletely Severed Tendon be Sutured?Plastic and Reconstructive Surgery, 57: 36–38.
27.
ROTHMANR. H., & SLOGOFFS. (1976) The Effect of Immobilisation on the Vascular Bed of Tendon. Surgery, Gynecology and Obstetrics124: 1064–1066.
28.
SETTIG. C., & VERDANC. (1973) A Study of the Lymphatic Circulation in Flexor Tendons. Proceedings of the 12th Congress of the International Society of Orthopaedic Surgeons and Traumatologists. Tel Aviv October 9-12 1972. Excerpta Medica 1973 (Orthopaedic Surgery and Traumatology), 305–307.
29.
SKOOGT., & PERSONB. H. (1954) An Experimental Study of the Early Healing of Tendons. Plastic and Reconstructive Surgery13: 384–399.
30.
URBANIAKJ. R., CAHILLJ. D., & MORTENSONR. A. (1974) Tendon Suturing Methods: Analysis of Tensile Strength. American Academy of Orthopaedic Surgeons. Symposium on Tendon Surgery in the Hand. Saint Louis.The C. V. Mosby Company, 70–80.
31.
VERDANC. E. (1972) Haifa Century of Flexor Tendon Surgery. Current Status and Changing Philosophies. The Journal of Bone and Joint Surgery, 54A: 472–491.