Kinouchi J
Nihon Seikeigeka Gakkai Zasshi. 1979 Feb;53(2):213-24.
The so-called two-stage procedure has been used in the reconstructive surgery for the severely injured flexor tendon of the finger. However, only little has been known as to vascularity of the grafted tendon within the pseudosheath. In order to clarify this problem, a series of experimental studies were carried out using young chickens. First, the flexor tendon of the fourth digit of chicken with its sheath was replaced by a silicone rod. The distal end of the rod was sutured to the stump of the flexor digitorum profundus and the proximal end left free. Then, in ten to sixteen weeks, upon removal of the rod, the flexor digitorum profundus of the third digit was grafted through into the newly formed pseudosheath. The paw was immobilized with plaster case in moderate flexion for three weeks, then the chicken was allowed to walk freely. At the different time intervals, starting from the third day to the fifteen weeks after surgery, a mode of vascularization of the grafted tendon and its surrounding tissue was examined microangiographically. The vessels appear at the area of proximal and distal stump of the grafted tendon a week postoperatively, and additional vessels appear at the contact area of the pseudosheath and the grafted tendon two weeks postoperatively. These vessels formed mutual anastomosis in five to six weeks. With time, the vessels connecting between the epitenon and the pseudosheath gradually enlarge and assemble together to form vascular bundles, so that the appearance of the structure becomes similar to that of the mesotenon. Three weeks postoperatively, the vessels appeared in the grafted tendon, and grew gradually so that these vessels ran through the full length of the grafted tendon in five to six weeks. About ten weeks, the vascularity of the grafted tendon is more abundant than that of the normal tendon, but diminished gradually so as to resemble that of the normal tendon at the fifteeth week. Thus, the growth of the vessels of the tendon grafted by two-stage procedure is delayed by two weeks compared with that by the primary tendon grafting.
所谓的两阶段手术已用于手指严重损伤屈指肌腱的重建手术。然而，对于移植肌腱在假腱鞘内的血管形成情况却知之甚少。为了阐明这一问题，我们使用幼鸡进行了一系列实验研究。首先，用硅胶棒替代鸡第四指的屈指肌腱及其腱鞘。将硅胶棒的远端缝合至指深屈肌的残端，近端保持游离。然后，在10至16周后，取出硅胶棒，将第三指的指深屈肌移植到新形成的假腱鞘内。用石膏托将爪子固定在适度屈曲位3周，然后让鸡自由行走。从术后第3天至第15周的不同时间间隔，通过微血管造影检查移植肌腱及其周围组织的血管形成模式。术后1周，血管出现在移植肌腱的近端和远端残端区域，术后2周，在假腱鞘与移植肌腱的接触区域出现额外的血管。这些血管在5至6周时形成相互吻合。随着时间的推移，连接腱周膜和假腱鞘的血管逐渐增粗并聚集在一起形成血管束，从而使结构外观变得类似于腱系膜。术后3周，血管出现在移植肌腱内，并逐渐生长，在5至6周时这些血管贯穿移植肌腱全长。约10周时，移植肌腱的血管比正常肌腱丰富，但逐渐减少，在第15周时类似于正常肌腱。因此，与一期肌腱移植相比，两阶段手术移植肌腱的血管生长延迟了2周。
