Adhesion formation after flexor tendon repair: a histologic and biomechanical comparison of 2- and 4-strand repairs in a chicken model

The development of digital oedema, adhesion formation, and resistance to digital motion at days 0, 3, 5, 7, 9 and 14 after primary flexor tendon repairs using 102 long toes of 51 Leghorn chickens was studied. Oedema presented as tissue swelling from days 3 to 7, which peaked at day 3. After day 7, oedema was manifest as hardening of subcutaneous tissue. The degree of digital swelling correlated with the resistance to tendon motion between days 3 and 7. At day 9, granulation tissues were observed around the tendon and loose adhesions were observed at day 14. Resistance to digital motion increased significantly from day 0 to day 3, but did not increase between days 3 and 9. The early postoperative changes appear to have three stages: initial (days 0–3, increasing resistance with development of oedema), delayed (days 4–7, higher resistance with continuing oedema) and late (after day 7–9, hardening of subcutaneous tissue with development of adhesions).

Download Full-text

A biomechanical comparison of techniques of flexor tendon repair

The Journal Of Hand Surgery ◽

10.1016/0363-5023(94)90101-5 ◽

1994 ◽

Vol 19 (6) ◽

pp. 979-983 ◽

Cited By ~ 63

Author(s):

William F. Wagner ◽

Charles Carroll ◽

James W. Strickland ◽

David A. Heck ◽

James P. Toombs

Keyword(s):

Flexor Tendon ◽

Tendon Repair ◽

Flexor Tendon Repair ◽

Comparison Of Techniques ◽

Biomechanical Comparison

Download Full-text

The Pathology of Flexor Tendon Repair

HAND ◽

10.1016/s0072-968x(79)80044-3 ◽

1979 ◽

Vol os-11 (3) ◽

pp. 233-242 ◽

Cited By ~ 13

Author(s):

Phillip Matthews

Keyword(s):

Recent Work ◽

Flexor Tendon ◽

Adhesion Formation ◽

Tendon Repair ◽

Tendon Tissue ◽

Flexor Tendon Repair ◽

Long Time ◽

The Subject ◽

Methods Of Treatment

This paper discusses the problems of failure after tendon repair. For a long time the subject has been dominated by the problem of adhesion formation. Recent work has shown that this is not inevitable, and consideration of other factors, particularly the nutrition of tendon tissue is leading to the possibilities of other methods of treatment.

Download Full-text

Four-Strand Core Suture Improves Flexor Tendon Repair Compared to Two-Strand Technique in a Rabbit Model

BioMed Research International ◽

10.1155/2016/4063137 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Alice Wichelhaus ◽

Sascha Tobias Beyersdoerfer ◽

Brigitte Vollmar ◽

Thomas Mittlmeier ◽

Philip Gierer

Keyword(s):

Suture Material ◽

Flexor Tendon ◽

Healing Process ◽

Adhesion Formation ◽

Rabbit Model ◽

Tendon Repair ◽

Initial Increase ◽

Suture Repair ◽

Flexor Tendon Repair ◽

The Third

Introduction. This study was designed to investigate the influence of the amount of suture material on the formation of peritendinous adhesions of intrasynovial flexor tendon repairs.Materials and Methods. In 14 rabbits, the flexor tendons of the third and the fourth digit of the right hind leg were cut and repaired using a 2- or 4-strand core suture technique. The repaired tendons were harvested after three and eight weeks. The range of motion of the affected toes was measured and the tendons were processed histologically. The distance between the transected tendon ends, the changes in the peritendinous space, and cellular and extracellular inflammatory reaction were quantified by different staining.Results. A 4-strand core suture resulted in significantly less gap formation. The 2-strand core suture showed a tendency to less adhesion formation. Doubling of the intratendinous suture material was accompanied by an initial increase in leukocyte infiltration and showed a greater amount of formation of myofibroblasts. From the third to the eighth week after flexor tendon repair, both the cellular and the extracellular inflammation decreased significantly.Conclusion. A 4-strand core suture repair leads to a significantly better tendon healing process with less diastasis between the sutured tendon ends despite initially pronounced inflammatory response.

Download Full-text

Biomechanical Comparison of a New Loop Suture Technique With Conventional Techniques of Flexor Tendon Repair

Annals of Plastic Surgery ◽

10.1097/sap.0000000000001625 ◽

2019 ◽

Vol 82 (4) ◽

pp. 441-444

Author(s):

Gokce Yildiran ◽

Osman Akdag ◽

Zekeriya Tosun

Keyword(s):

Flexor Tendon ◽

Tendon Repair ◽

Suture Technique ◽

Flexor Tendon Repair ◽

Biomechanical Comparison

Download Full-text

An Overview of the Management of Flexor Tendon Injuries

The Open Orthopaedics Journal ◽

10.2174/1874325001206010028 ◽

2012 ◽

Vol 6 (1) ◽

pp. 28-35 ◽

Cited By ~ 49

Author(s):

M Griffin ◽

S Hindocha ◽

D Jordan ◽

M Saleh ◽

W Khan

Keyword(s):

Flexor Tendon ◽

Current Knowledge ◽

Adhesion Formation ◽

Tendon Repair ◽

Tendon Injury ◽

Tendon Injuries ◽

Flexor Tendon Repair ◽

Flexor Tendon Injury ◽

Post Surgery ◽

Flexor Tendon Injuries

Flexor tendon injuries still remain a challenging condition to manage to ensure optimal outcome for the patient. Since the first flexor tendon repair was described by Kirchmayr in 1917, several approaches to flexor tendon injury have enabled successful repairs rates of 70-90%. Primary surgical repair results in better functional outcome compared to secondary repair or tendon graft surgery. Flexor tendon injury repair has been extensively researched and the literature demonstrates successful repair requires minimal gapping at the repair site or interference with tendon vascularity, secure suture knots, smooth junction of tendon end and having sufficient strength for healing. However, the exact surgical approach to achieve success being currently used among surgeons is still controversial. Therefore, this review aims to discuss the results of studies demonstrating the current knowledge regarding the optimal approach for flexor tendon repair. Post-operative rehabilitation for flexor tendon surgery is another area, which has caused extensive debate in hand surgery. The trend to more active mobilisation protocols seems to be favoured but further study in this area is needed to find the protocol, which achieves function and gliding but avoids rupture of the tendons. Lastly despite success following surgery complications commonly still occur post surgery, including adhesion formation, tendon rupture and stiffness of the joints. Therefore, this review aims to discuss the appropriate management of these difficulties post surgery. New techniques in management of flexor tendon will also be discussed including external laser devices, addition of growth factors and cytokines.

Download Full-text