DeGeorge Brent R, Rodeheaver George T, Drake David B
From the Department of Plastic Surgery, University of Virginia Medical Center, Charlottesville, VA.
Ann Plast Surg. 2014;72(6):S184-90. doi: 10.1097/SAP.0000000000000097.
Devastating volar hand injuries with significant damage to the skin and soft tissues, pulley structures and fibro-osseous sheath, flexor tendons, and volar plates pose a major problem to the reconstructive hand surgeon. Despite advances in tendon handling, operative technique, and postoperative hand rehabilitation, patients who have undergone flexor tendon reconstruction are often plagued by chronic pain, stiffness, and decreased range of motion with resultant decreased ability to work and poor quality of life. In this article, we expand the technique of human composite flexor tendon allografts (CFTAs), pioneered by Dr E.E. Peacock, Jr, which consist of both the intrasynovial and extrasynovial flexor digitorum superficialis and flexor digitorum profundus tendons and their respective fibro-osseous sheath consisting of the digital pulley structures, periosteum, and volar plates procured from cadaveric donors with the use of modern tissue processing techniques.
Human cadaveric CFTAs were procured and divided into 2 groups-unprocessed CFTAs and processed CFTAs, which are cleansed and sterilized to a sterility assurance level of 10(-6). Physical length and width relationships as well as tensile strength and gliding resistance assessments were recorded pre-tissue and post-tissue processing. The histologic properties of the composite allografts were assessed before and after tissue processing.
There was no significant difference with respect to physical properties of the composite allografts before or after tissue processing. The processed composite allografts demonstrated equivalent maximum load to failure and elastic modulus compared to unprocessed tendons. The gliding resistance of the composite tendon allografts was not significantly different between the 2 groups.
The use of CFTAs addresses the issues of adhesion formation and lack of suitable donor material by providing a source of intrasynovial tendon in its unaltered fibro-osseous sheath without donor morbidity. This approach represents an important step toward designing an ideal material for complex flexor tendon reconstruction, which takes advantage of an intrasynovial flexor tendon in its native fibro-osseous sheath without the need for additional donor morbidity using a construct which can be engineered to have minimal tissue reactivity, negligible potential for disease transmission, and improved tendon healing properties versus standard tendon allograft.
严重的手掌掌侧损伤，伴有皮肤和软组织、滑车结构和纤维骨鞘、屈肌腱以及掌侧板的显著损伤，给手部重建外科医生带来了重大问题。尽管在肌腱处理、手术技术和术后手部康复方面取得了进展，但接受屈肌腱重建的患者常常受到慢性疼痛、僵硬和活动范围减小的困扰，导致工作能力下降和生活质量不佳。在本文中，我们扩展了由小E.E.皮科克博士开创的人类复合屈肌腱同种异体移植（CFTAs）技术，该技术包括滑膜内和滑膜外的指浅屈肌腱和指深屈肌腱，以及它们各自的纤维骨鞘，纤维骨鞘由指滑车结构、骨膜和掌侧板组成，这些均从尸体供体获取，并采用现代组织处理技术。
获取人类尸体CFTAs并分为两组——未处理的CFTAs和已处理的CFTAs，已处理的CFTAs经过清洗和消毒，达到无菌保证水平10^(-6)。记录组织处理前后的物理长度和宽度关系以及拉伸强度和滑动阻力评估结果。对复合同种异体移植物的组织学特性在组织处理前后进行评估。
组织处理前后复合同种异体移植物的物理特性没有显著差异。与未处理的肌腱相比，已处理的复合同种异体移植物表现出相当的最大破坏载荷和弹性模量。两组之间复合肌腱同种异体移植物的滑动阻力没有显著差异。
使用CFTAs通过在未改变的纤维骨鞘中提供滑膜内肌腱来源且无供体并发症，解决了粘连形成和缺乏合适供体材料的问题。这种方法代表了朝着设计用于复杂屈肌腱重建的理想材料迈出的重要一步，该材料利用处于天然纤维骨鞘中的滑膜内屈肌腱，无需额外的供体并发症，使用的构建体可设计为具有最小的组织反应性、可忽略的疾病传播可能性以及与标准肌腱同种异体移植相比改善的肌腱愈合特性。
