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.

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.

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

The Effect of Suture Technique on Adhesion Formation after Flexor Tendon Repair for Partial Lacerations in a Canine Model

2001 ◽  
Vol 51 (5) ◽  
pp. 917-921 ◽  
Author(s):  
Chunfeng Zhao ◽  
Peter C. Amadio ◽  
Toshimitsu Momose ◽  
Paulus Couvreur ◽  
Mark E. Zobitz ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Canine Model ◽  
Suture Technique ◽  
Flexor Tendon Repair

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

2004 ◽  
Vol 29 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Margaret J Strick ◽  
Susan L Filan ◽  
Mark Hile ◽  
Catriona McKenzie ◽  
William R Walsh ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Biomechanical Comparison ◽  
Chicken Model

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.

AN INVERTING CIRCUMFERENTIAL SUTURE FOR FLEXOR TENORRAPHY

Hand Surgery ◽  
2011 ◽  
Vol 16 (02) ◽  
pp. 133-139 ◽  
Author(s):  
P. J. Sullivan ◽  
K. M. Hirpara ◽  
C. E. Healy ◽  
P. Dockery ◽  
J. L. Kelly
Keyword(s):  
Flexor Tendon ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Gap Formation ◽  
Flexor Tendon Repair ◽  
Improved Outcomes ◽  
Load To Failure ◽  
Poor Outcomes ◽  
Suturing Methods

Zone two flexor tendon repair remains challenging with significant outcome variation using recognised techniques. Tendon adhesion formation results in poor outcomes and rehabilitation regimes aim to limit this. Some repairs augment strength, but increasing bulk mitigates against movement. This novel epitendinous technique causes tendon inversion with potential gliding benefits and improved outcomes. 60 porcine tendons were randomised to a 2-stranded modified Kessler or a 4-stranded Adelaide repair, then sudivided into three different circumferential technique groups: locked running, Silfverskiold, or a new inverting repair. Tendon load to failure (LTF), 2 mm gap formation, bulking effect and method of failure were analysed during digital tensiometry. Four-stranded repairs demonstrated better LTF than 2-stranded techniques. The inverting epitendinous and Silfverskiold repairs showed higher LTF characteristics than the locked running suture, and better tissue holding capacity. The inverting repair has similar properties to commonly used suturing methods and the conformation creates a smooth inverted repair.

THE EFFECT OF THERMAL PRECONDITIONING OF THE LIMB ON FLEXOR TENDON HEALING

2007 ◽  
Vol 32 (3) ◽  
pp. 289-295 ◽  
Author(s):  
C. HEALY ◽  
K. J. MULHALL ◽  
D. FITZ PATRICK ◽  
E. W. KAY ◽  
D. BOUCHIER-HAYES
Keyword(s):  
Heat Shock ◽  
Flexor Tendon ◽  
Adhesion Formation ◽  
Rabbit Model ◽  
Tendon Repair ◽  
Tendon Healing ◽  
Flexor Tendon Repair ◽  
Treatment Groups ◽  
Tendon Surgery ◽  
Thermal Preconditioning

Thermal preconditioning reduces inflammation by inducing cytoprotective heat shock proteins. We evaluated the role of limb thermal preconditioning in a rabbit model of flexor tendon repair. The treatment groups underwent limb preconditioning by elevating the limb temperature to 41.5 °C for 20 minutes. The animals were sacrificed three and six weeks after flexor tendon repair. Heat shock protein72 expression of the treated limb was measured at 18 hours. Macroscopic analysis demonstrated a significant decrease in adhesion formation in the three week treatment group. The inflammatory infiltrate was significantly reduced for both treatment groups. The difference in ultimate tensile strength was not significant. We conclude that thermal preconditioning of the limb before flexor tendon repair decreases inflammation and adhesion formation in a rabbit model and has the potential to improve clinical outcome of flexor tendon surgery.

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