The growth factors involved in flexor tendon repair and adhesion formation

2013 ◽  
Vol 39 (1) ◽  
pp. 60-70 ◽  
Author(s):  
O. A. Branford ◽  
B. R. Klass ◽  
A. O. Grobbelaar ◽  
K. J. Rolfe
Keyword(s):  
Growth Factors ◽  
Tendon Rupture ◽  
Flexor Tendon ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Clinical Problem ◽  
Flexor Tendon Repair ◽  
Flexor Tendon Injuries ◽  
Targeted Approach ◽  
Main Growth

Flexor tendon injuries remain a significant clinical problem, owing to the formation of adhesions or tendon rupture. A number of strategies have been tried to improve outcomes, but as yet none are routinely used in clinical practice. Understanding the role that growth factors play in tendon repair should enable a more targeted approach to be developed to improve the results of flexor tendon repair. This review describes the main growth factors in tendon wound healing, and the role they play in both repair and adhesion formation.

scholarly journals An Overview of the Management of Flexor Tendon Injuries

2012 ◽  
Vol 6 (1) ◽  
pp. 28-35 ◽  
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.

scholarly journals Wide-Awake Flexor Tendon Repair Under Tumescent Injection

2019 ◽  
Vol 1 (1) ◽  
pp. 39-51
Author(s):  
Hanan Abid ◽  
Sabah Naji
Keyword(s):  
Range Of Motion ◽  
Tendon Rupture ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Active Movement ◽  
Flexor Tendon Repair ◽  
Examination Result ◽  
Flexor Tendon Injuries ◽  
Zone Ii ◽  
No Tourniquet

Background. Flexor tendon injuries are frequent, due to variable hand activities, and the repair is challenging to hand surgeons, especially in zone II, because of the coexistence of two tendons within a tight fibro-osseous tunnel. Flexor tendon repair under tumescent infiltration provides anesthesia and a bloodless field, so that no tourniquet or sedation is needed. Aim of study. The goal of this study was to identify a surgical adjustment and intraoperative total active movement examination of the repaired tendon so that no gapping is formed, and smooth gliding is obtained, avoiding tendon rupture and producing an optimal range of motion. Patients and method. From January 2016 to April 2017, 9 patients (17 tendons), with a mean age of 31.8 years, presented within 3 to 14 days of injury to zone I or zone II of their flexor tendons. Tendon repair was done under tumescent infiltration (lidocaine 1% with adrenaline 1:200,000) only, with no tourniquet or sedation, and with an intraoperative total active movement examination. Result. After 6 months of follow up, all the patients had excellent range of motion according to the Boyes outcome scale, and none showed signs of postoperative tendon rupture. Conclusion. Tumescent infiltration for flexor tendon repair allows intraoperative surgical adjustment and total active movement examination, which will minimize postoperative rupture and adhesion. This procedure will also facilitate the surgeon’s work by eliminating the need for general anesthesia or sedation; however, this procedure is not applicable for children, major trauma, or those who are mentally challenged.

Tendons

2011 ◽  
Author(s):  
David Warwick ◽  
Roderick Dunn ◽  
Erman Melikyan ◽  
Jane Vadher
Keyword(s):  
Tendon Rupture ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Healing ◽  
Extensor Tendon ◽  
Suture Techniques ◽  
Flexor Tendon Repair ◽  
Tendon Suture ◽  
Anatomy And Physiology ◽  
Flexor Tendon Rupture

Anatomy and physiology 392Tendon healing 394Flexor tendon anatomy 396Flexor tendon zones of injury 400Flexor tendon suture techniques 402Flexor tendon repair 404Closed flexor tendon rupture 410Flexor tenolysis 412Flexor tendon reconstruction 414Extensor tendon anatomy 418Extensor tendon repair ...

scholarly journals Systemic EP4 Inhibition Increases Adhesion Formation in a Murine Model of Flexor Tendon Repair

PLoS ONE ◽  
2015 ◽  
Vol 10 (8) ◽  
pp. e0136351 ◽  
Author(s):  
Michael B. Geary ◽  
Caitlin A. Orner ◽  
Fatima Bawany ◽  
Hani A. Awad ◽  
Warren C. Hammert ◽  
...  
Keyword(s):  
Murine Model ◽  
Flexor Tendon ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Flexor Tendon Repair

Digital Oedema, Adhesion Formation and Resistance to Digital Motion after Primary Flexor Tendon Repair

2008 ◽  
Vol 33 (6) ◽  
pp. 745-752 ◽  
Author(s):  
Y. CAO ◽  
C. H. CHEN ◽  
Y. F. WU ◽  
X. F. XU ◽  
R. G. XIE ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Subcutaneous Tissue ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Postoperative Changes ◽  
Three Stages

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).

The Pathology of Flexor Tendon Repair

HAND ◽  
1979 ◽  
Vol os-11 (3) ◽  
pp. 233-242 ◽  
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.

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

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
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.

Flexor Tendon Repair in Zone 2 Followed by Controlled Active Mobilisation

1989 ◽  
Vol 14 (4) ◽  
pp. 392-395
Author(s):  
K. W. CULLEN ◽  
PAMELA TOLHURST ◽  
D. LANG ◽  
R. E. PAGE
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Adult Patients ◽  
Flexor Tendon Repair ◽  
Flexor Tendon Injuries

Over a two-year-period, 34 adult patients who had suffered zone two flexor tendon injuries to 38 fingers (70 tendons) were managed post-operatively by a regime of early active mobilisation. The results of this technique, assessed by the Strickland criteria after a mean follow-up period of 10.2 months, compared favourably with other more cumbersome methods.

The Effect of Seprafilm on Adhesion Formation and Tendon Healing After Flexor Tendon Repair in Chicken

Orthopedics ◽  
2010 ◽  
Vol 33 (3) ◽  
pp. 164-170 ◽  
Author(s):  
Erhan Yilmaz ◽  
Mustafa Avci ◽  
Mehmet Bulut ◽  
Halidun Kelestimur ◽  
Lokman Karakurt ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Tendon Healing ◽  
Flexor Tendon Repair

Flexor tendon injuries in the child

2013 ◽  
Vol 39 (1) ◽  
pp. 46-53 ◽  
Author(s):  
M. M. Al-Qattan
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Skin Closure ◽  
Two Stage ◽  
Flexor Tendon Repair ◽  
Technical Aspects ◽  
Tendon Reconstruction ◽  
Flexor Tendons ◽  
Flexor Tendon Injuries

This review aims to highlight the differences in the management of flexor tendon injuries between children and adults. These include differences in epidemiology, anatomy, classification, diagnosis, incisions and skin closure, the size of the flexor tendons, technical aspects of zones I and II repairs, core suture purchase length, rehabilitation, results, and complications of primary flexor tendon repair. Finally, one- versus two-stage flexor tendon reconstruction in children is reviewed.

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