Eiken O, Lundborg G, Rank F
Scand J Plast Reconstr Surg. 1975;9(3):182-9. doi: 10.3109/02844317509022864.
The mechanism of healing of a free tendon graft and also the role played by the synovial sheath is still obscure and debated. In the present study an effort is made to further elucidate these problems. In rabbits and dogs an experimental model was developed where a free tendon graft would be nourished by synovial fluid only. Macroscopically the grafts remained smooth, white and glistening without vascular ingrowth or adhesions during an observation period of 12 weeks. By histological and histochemical techniques the grafts as a whole were found viable up to 3 weeks. In a clinical series of 40 free flexor tendon grafts within the digital area as much as possible of the tendon sheath was preserved during grafting. The functional recovery was generally very good. The best results were obtained in those cases where most of the tendon sheath was preserved during grafting. The functional recovery was generally very good. The best results were obtained in those cases where most of the tendon sheath was preserved. No signs of defective graft survival were observed. Based on both experimental and clinical results from the present study it is concluded that there is no reason to excise the remaining tendon sheath within the critical zone in the digits. On the contrary preservation of the sheath contributes to survival of the graft and helps maintaining the integrity of gliding surfaces with maximal functional restoration and minimal formation of adhesions.
游离肌腱移植的愈合机制以及滑膜鞘所起的作用仍不明确且存在争议。在本研究中，我们努力进一步阐明这些问题。在兔和犬身上建立了一个实验模型，使游离肌腱移植仅由滑液滋养。在12周的观察期内，肉眼可见移植物保持光滑、白色且有光泽，没有血管长入或粘连。通过组织学和组织化学技术发现，移植物整体在3周内都是存活的。在一组40例手指区域游离屈肌腱移植的临床病例中，移植过程中尽可能保留了腱鞘。功能恢复总体上非常好。在那些移植过程中大部分腱鞘得以保留的病例中，取得了最佳效果。功能恢复总体上非常好。在那些大部分腱鞘得以保留的病例中，取得了最佳效果。未观察到移植物存活不良的迹象。基于本研究的实验和临床结果，得出结论：没有理由切除手指关键区域内剩余的腱鞘。相反，保留腱鞘有助于移植物存活，并有助于维持滑动面的完整性，实现最大程度的功能恢复以及最小程度的粘连形成。
