Effect of various methods of restoring flexor sheath integrity on the formation of adhesions after tendon injury

Abstract

The effect of three different methods of restoring flexor sheath integrity on the formation of adhesions around traumatized flexor tendons was studied by use of a chicken animal model. The three methods were: I, Primary sheath repair; II, a fascia patch; and III, a synthetic polytetrafluoroethylene surgical membrane patch. These were compared with controls in which the flexor sheath was excised. Adhesion formation was assessed both biomechanically by measuring the parameter work of flexion, (which represents the resistance to tendon gliding caused by adhesions), and also histologically. At 3 and 6 weeks there was no significant difference in the work of flexion between either the sheath repair or fascia patch digits, and the sheath excised controls. However, use of the synthetic polytetrafluorethylene patch did result in tendon gliding, which was significantly better than the controls. In contrast, at 12 weeks all three methods of sheath reconstruction had similar tendon gliding biomechanics, and all were significantly better than the controls. Histologically, at 3 weeks, the biologic barriers sheath repair and fascia patch were associated with a layer of granulation tissue, which adhered to the underlying tendon. This was similar to the appearance of the sheath excised control digits. The synthetic patch was not associated with a significant inflammatory reaction at this time period and was clearly separated from the tendon. However, by 6 and 12 weeks the granulation tissue in all three sheath reconstruction groups had undergone remodeling to a greater degree than had the controls.(ABSTRACT TRUNCATED AT 250 WORDS)