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An Experimental Study Of The Repair And Gliding Function Of Digital Flexor Tendon Following Injury

Yukuo Tokita, Akio Yamaya, Y. Ito, T. Fukuoka, Kenichiro Uchinishi, Y. Yabe
Published 2004 · Medicine

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SummaryThe profundus tendons of young adult chickens have been used to study flexor tendon healing within the digital sheath. Histological observation has shown that the preserved digital sheath prevented the tendon healing with adhesions and that the epitendon played a leading role in the process of tendon repair. Muscle tension must be removed from the sutured site for tendon repair without adhesion. Post-operative immobilisation in the “tension-reducing position”, in which an operated digit is flexed and the rest of the digits are extended, is believed to be one of the most efficient procedures for removing tension from the sutured site of the tendon. Three methods of tendon suture were used — Bunnell crisscross stitch, modified double right-angle suture, and interrupted suture. Least adhesions were noted in the tendons sutured by interrupted suture, and the tensile strength of the tendons sutured by interrupted suture tended to be highest between three and six weeks postoperatively. To achieve tendon healing with good gliding function, the following procedures should be observed: (1) preservation of the digital sheath, (2) an atraumatic technique for tendon suture, and (3) immobilisation in the “tension-reducing position”.RésuméOn a utilisé le tendon fléchisseur profond du poulet pour étudier la cicatrisation des tendons fléchisseurs des doigts à l'intérieur de la gaine digitale. Les examens anatomo-pathologiques ont montré que la conservation de la gaine évitait la formation d'adhérences et que l'épitendon jouait un rôle majeur dans le processus de réparation du tendon, en l'absence de ces adhérences.Pour obtenir cette cicatrisation sans adhérences, il faut supprimer toute tension en regard de la zone suturée. L'immobilisation post-opératoire dans une position de relâchement, le doigt opéré étant fléchi et les autres étendus, paraît être un des meilleurs procédés pour supprimer cette tension.Parmi les trois méthodes de suture tendineuse: laçage à la Sterling Bunnell, suture modifiée à double angle droit et suture à points séparés, c'est cette dernière qui donne le moins lieu à la formation d'adhérences. Et c'est entre la 3ème et la 6ème semaine post-opératoire que la résistance à la traction du tendon ainsi suturé est la plus élevée.Pour obtenir la cicatrisation tendineuse avec une bonne récupération fonctionnelle, les points de technique suivants sont donc essentiels: (1) préservation de la gaine digitale, (2) technique atraumatique de suture du tendon et (3) immobilisation du doigt en position de relâchement.
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