Restoration of the Digital Tendon Sheath

The repair of flexor tendons which have been divided within the digital sheath remains an unsolved problem. Adhesions occur at wound sites and points of tendon trauma. It is well known that an intact digital canal prevents formation of adhesions. Previous studies in chickens have shown that autologous tendon sheath tissue can successfully be transplanted from one digit to another with preserved vitality and that by this technique the continuity of an injured tendon sheath can be restored. The present series represent a clinical application of this new concept. 40 patients with flexor tendon injuries within the critical zone in the finger were treated by the use of a two-stage tendon grafting procedure. In the first stage operation the continuity of the tendon sheath was restored by transplantation of autologous synovial tissue. In the second procedure 3 months later a conventional tendon grafting was performed. Using the criteria of Boyes & Stark (1971) successful results were obtained in 88%. It can be concluded that the present method of tendon grafting provides a favourable recipient bed and improved gliding conditions.