Reduction of restrictive adhesions by local aprotinin application and primary sheath repair in surgically traumatized flexor tendons of the rabbit.

The effects of microsurgical and medical treatments on reduction of adhesions in surgically traumatized flexor tendons of rabbits are quantified in this study. The effects of the mentioned techniques were investigated for the following 4 groups: (1) neither primary sheath repair nor aprotinin application was done, (2) primary sheath repair was done but no aprotinin was used, (3) primary sheath repair was not done but local aprotinin (15,000 IU/kg) was applied, and (4) primary sheath repair was done and local aprotinin was applied. At the sixth and twelfth postoperative weeks, the flexor digitorum profundus tendons of the second and the third digits were subjected to biomechanical tests. Only the third digit was used in macroscopic and histopathologic evaluations. There were 6 digits included in each subgroup of biomechanical tests and 4 digits per subgroups in macroscopic and histopathologic evaluations. Work of flexion (WOF) values were obtained by calculating the area under the load-displacement curve. Percent resistive work of flexion (PRWOF) was obtained by calculating the difference between the WOF value for the repaired right digit and the WOF value for the contralateral corresponding nonrepaired digit. Combined primary sheath repair and medical treatment yielded the best results in reducing the restrictive adhesions in injured tendons. The differences between the PRWOF values of group 4 were 33.7% +/- 8.2% and 15.8% +/- 7.7% for the sixth and twelfth postoperative weeks, respectively. The corresponding values for group 1 were 95.7% +/- 13.8% and 51.75% +/- 10.25%.