Flexor Tendon Injuries –Repair and Reconstruction-Biologic Aspects of Flexor Tendon Laceration and Repair

Biologic Aspects of Flexor Tendon Laceration and Repair

Pdf Summary

Flexor tendon repairs in the hand often result in peritendinous adhesions, which can lead to loss of normal tendon gliding, digital stiffness, and functional disability. Advances in suture techniques and rehabilitation protocols have improved tendon repair outcomes, but functional restoration is still not consistently achieved. Recent progress in understanding the biology of tissue healing may lead to enhanced flexor tendon healing. Therapeutic strategies for scar reduction after flexor tendon injury include manipulation of cytokine levels, introduction of genetic material into cells, and addition of pluripotential mesenchymal stem cells at the repair site. Restoring normal hand function after flexor tendon laceration requires reestablishing both the continuity of the tendon fibers and the gliding mechanism between the tendon and surrounding structures. Scar tissue formation between the tendon ends provides physical continuity but can impede tendon gliding and lead to functional limitations. The formation of adhesions between the tendon and its sheath is of particular concern in zone II of the flexor tendon system. Improved surgical methods and rehabilitation protocols have made primary repair of flexor tendon lacerations the standard of care, but postoperative scarring and adhesion formation still occur frequently. Further research is needed to improve outcomes in this area. The biologic modulation of tendon healing may incorporate the finest suture repair techniques, postoperative rehabilitation protocols, and optimal biologic modulation of the healing response. The recent understanding of the molecular biology of soft tissue healing has shed light on the healing processes of tendon tissue, offering potential solutions for enhancing tendon healing and reducing adhesion formation. The study of fetal tissue responses to injury, which heal without scarring, could provide valuable insights for achieving scarless healing in adult tissues. Gene therapy, particularly the introduction of genetic material into cells, offers potential applications in enhancing tendon healing, preventing adhesion formation, and improving the strength of repairs. Another promising avenue is the use of cell therapies involving mesenchymal stem cells, which have the potential to differentiate into tendon fibroblasts and produce growth factors necessary for tendon repair. However, more research is needed to understand the mechanisms and potential clinical applications of these treatments.

Keywords

flexor tendon repairs

peritendinous adhesions

tendon gliding

digital stiffness

functional disability

suture techniques

rehabilitation protocols

tendon laceration

adhesion formation

mesenchymal stem cells