Primary Repair without Immobilization of Flexor Tendon Division within the Digital Sheath: An Experimental and Clinical Study

The prevention of peritendinous adhesions by a phospholipid polymer hydrogel formed in situ by spontaneous intermolecular interactions

“…[5][6][7][8][9]. A possible mechanism for this adhesion resistance lies in the honeycomb microstructure with nanometer-scaled pores of the MPC hydrogel; these are assumed to block passage of extrinsic fibroblastic cells (more than 8-10 mm in diameter) for the peritendinous adhesions but allow passage of cytokines and growth factors for the tendon healing [23,24] (Fig.…”

“…Now, however, it is well known that tendon healing can, and ideally should, occur in the absence of peritendinous adhesions and through the intrinsic process: by the activity of tenocytes in the tendon sheath with sufficient supplies of cytokines and growth factors from the outside [5,6]. Despite advances in surgical techniques and rehabilitation programs [7,8], the results of tendon repair within the sheath remain largely unpredictable [1,2]. Hence, many modalities have been investigated to prevent adhesion formation such as the use of pharmacologic modulators or mechanical barriers between the tendon and surrounding tissues [9][10][11][12][13][14][15][16][17][18].…”

The Importance of Controlled Passive Mobilization on Flexor Tendon Healing:A Biomechanical Study

“…The sheath was incised at the proximal interphalangeal (IP) joint and the flexor superficialis decussation. The lacerated tendons were repaired in the manner described by Kessler & Nissim (1969) with 4-0 braided dacron suture under 3.5 times magnification. A continuous 6-0 nylon epitenon suture was inserted to invaginate free tendon ends (Figure 1).…”

In vitro biomechanical analysis of suture methods for flexor tendon repair

“…Recently, both Savage (23) and Lee (16) described new suture methods designed to withstand early active mobilization. Savage showed that a six-strand method had an average ultimate load of 84 N, compared with the conventional two-strand method which withstood only 23 N. Using human tendons, Lee found that his suture method yielded an average ultimate load of 43 N, compared with 22 N for the more conventional Kessler method (12).…”