Clinical aspects of tendon healing

We know that healing of a tendon wound takes place by an invasion of fibreblasts from the surrounding tissues; the tendon itself has no intrinsic healing capacity. lt was Potenza (1962) who proved that a traumatic suture of the tendons within their sheath is followed by disintegration of the synovia and the formation of granulation tissue. The tissue invades the tendon at those places where its surface is wounded and forms new collagen which restores its continuity. As soon as this scar tissue matures, the adhesions become looser and the integrity of the sheath is repaired. Potenza (1963) also observed that when contact between the tendon and its sheath is made impossible by the introduction of polyethylene tubes or millipore, healing of the tendon wound is postponed until granulation tissue has invaded the tube from its end and reached the wound along the surface of the tendon. However, trauma is not always restricted to a loss of continuity; circulatory loss may also occur and the consequences of deprivation of a tendon's blood supply force us to study the role of its circulation during healing

Man and his hand

Introduction: In a world where mechanisation and automation have led to a devaluation of skilled manual work, and where only certain press and publicity media doubt the superiority of the mind, the following operating-theatre dialogue is refreshing: Surgeon: The surgeon's hands are his finest instruments. Physician: Anyway, he can't lose them in the abdomen. The surgeon praises his hands and the work they enable him to do. The physician expresses his doubts about the reasoning powers that are responsible for this work. Such a dialogue invites discussion on the subject of the hand, and also provides me with an opportunity for making a few remarks about the relation between surgeon and physician. As you will all know, it was usual until recently to make a distinction between physicians and surgeons, based on the supposition that the two were birds of a different plumage. The physicians were supposed to be heirs of the age-old venerable school of Aesculapios, while the surgeons were descended from the less respectable ranks of the barbers and lithotomists. However, history teaches us that the link between physician and surgeon is closer than is often thought

Present State of Knowledge on Processes of Healing in Collagen Structures

Introduction: The greatly increasing number of sport injuries among both youth and older people and the diversity of these injuries necessitates an individual treatment of the patient and his or her injury. In order to be able to give this individual treatment, however, it is necessary to have a basic knowledge concerning the healing process of a wound. We can all indicate the exact moment when this process begins, namely at the time of trauma. However, it is difficult to say when recovery is complete. This contribution, in which the various phases of the healing process of wounds are described, makes it clear why this is so

Factors influencing wound healing

Until comparatively recently it was considered to be self-evident that wound healing and infection were both parts of the same process. The words 'laudable pus' speak for themselves. De Chauliac and Pare were amongst the first generation of surgeons who were dissatisfied with this concept, and showed that healing could be achieved without infection if better treatment was applied to the wound. Semmf'lweis and Lister clearly showed that the two processes were distinct, and thus laid the basis for modern surgery. Nowadays the roles are reversed, and there appears to be a real danger of wound healing without infection being taken for granted. Many are unaware that most complications can be prevented, because they do not have satisfactory knowledge of the healing process. A surgeon-to-be must therefore become conversant with the basic principles of this process. He must accurately assess the damage caused by the wound and the body's capacity for repairing this damage. He must learn to allow nature to take its course, and only to interfere when nature threatens to 'go astray'. But, first of all, he must begin at the beginning and realize that three important phases in the healing process can be differentiated: a reaction phase, a regeneration phase, and a remodelling phase

De gezonde en de gewonde hand

Rede, uitgesproken bij de aanvaarding van het bijzondere lectoraat van de Plastiche Chirurgie en met name de chirurgie van de hand, vanwege de Stichting Fonds Medische Faculteit, Erasmus Universiteit Rotterdam, op woensdag 19 juni 197

Recent advances in flexor tendon repair

The prognosis for restoration of good function after the treatment of a tendon lesion in 'no-man's land' is influenced by a number of factors which may be summarized as follows: - The nature of the injury. - The amplitude of the tendon excursion. - The motility of the hand. - The age of the patient. - The rehabilitation of the patient. Excellent results may usually be achieved when the preoperative conditions are favourable. Unsatisfactory results usually follow when: - the neurovascular bundles are injured and the posterior wall of the tendon sheath is damaged, - the amplitude of excursion of the divided tendon is large, - the skin of the hand is thick and tough, - the patient is more than 20 years old, - the rehabilitation of the patient is insufficient. ..

Clinical aspects of flexor tendon healing

Consideration of the clinical aspects of tendon healing calls first for an evaluation of the role of the different structures involved

The treatment of prolapse and collapse of the proximal interphalangeal joint

It is intended here to discuss the correction of these deformities rather than the treatment of the conditions leading to prolapse and collapse. Most hand surgeons will agree that in this kind of surgery success and failure go hand in hand and that it is difficult to separate the two. The success of treatment, in our opinion, is determined by a number of factors which we have tried to summarise as follows: 1. Timing of correction. 2. Nature of correction. 3. Period of immobilisation. 4. Prevention of adhesion formation. 5. Effect of devascularisation

Causes of prolapse and collapse of the proximal interphalangeal joint

An understanding of abnormal finger motion depends on a basic knowledge of normal functional anatomy, which can be found in the contributions made by Eyler and Markee (1954), Kaplan (1953), Milford (1968), Stack (1962), Tubiana and Valeillin (1963). It is then possible to appreciate that the finger is a combination of two biarticular, bimuscular systems: a proximal system consisting of the metacarpophalangeal joint and the proximal interphalangeal joint, and a distal system consisting of the proximal interphalangeal and the distal interphalangeal joints. In such a biarticular bimuscular system four combinations of joint positions are found: Extension-extension, extension-flexion. flexion-flexion, and flexion-extension (Stack, 1962). Movement being a synonym for a change of position, twelve different motions are possible: eight single actions involving only one joint, and four double motions involving two joints

Hypospadias

The known literature on hypospadias largely concerns the treatment of this anomaly, and the related disturbances in wound healing. The morphology of this anomaly and the factors underlying a disturbance in wound healing, however, receive comparatively !ittle attention. A discussion of the morphology is as a rule confined to mentioning the location of the meatus and such curvature as is present. Very few authors also elucidate other aspects such as the oblique rap hes, the inlegurnental volume deficiency on the urethra! side, the dog-ears on the dorsal side, etc. Little is known about these changes, which also occur in a number of anomalies related to hypospadias, such as congenital urethra! fistula and hypospadias without hypospadias. This excited our interest, and we decided to investigate !heir pathogenesis and possible significanee in terros of treatment. In view of a number of disappointments experienced, we decided to combine this study with an analysis of the various operalive methods, and the factors which can lead to a disturbance in wound healing. The results of this investigation are reported in this thesi