Huffstadt, Adolf Johan Casimir

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Proceedings - University of Groningen

   University of GroningenVrije peestransplantatie bij de behandeling van buigpeesletsels aan duim en vingers.Huffstadt, Adolf Johan CasimirIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:1958Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Huffstadt, A. J. C. (1958). Vrije peestransplantatie bij de behandeling van buigpeesletsels aan duim envingers. Koninklijke Van Gorcum.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 03-06-2022n d e)Pentelijkeen(hiercces.risse-e be-€ d .. aan-leerdtl enLtie isSUMMARYIN Chapter l the lay-out of this work, dealing with flexor tendon lesions, is discussed.As n g,riil., the syÁtem of RnNr and WRrEErEro is used, who in turn have taken overprinciples of BuNNsn.The directives for the treatment of flexor tendon lesions of the thumb and fingersin the area of the sheaths are:a Primary treatment, consisting of wound care and eventual primary nerve sutu-re'The tendon ends and sheaths are untouched. An antibiotic is given prophylactically'b Reconstruction of the profundus tendon with a free tendon graft- is undertaken assoon as the wound is soundly healed, the passive mobility in the finger joints isnormal and if there are no trophic disturbances.c To standardize and simplify the technique, one system is followed as far as possible'The value of the hand to man is pointed out and the treatment of hand injuries discussed'The use of rehabilitation is emphasized.ln Chapter // the anatomy is discussed, as far as it relates to the tendon lesions inquestion.In Chapter 11/ an extensive survey of tendon healing is given, as worked out experiment-ally by MRsoN and AuEN.The aims of tendon surgery are:c To restore continuity of the tendon.b Mobility of the treated tendon with regard to its surrounding tissues.A better understanding of the course of tendon healing gives directives for the surgicaltreatment and. for the aftercare.MasoN and AuEN studied experimental tenclon sutures under various conditionsin dogs. The healing of the tendon was judged by its tensile strength.They came to the following conclusions:Tendon healing shows three Phases:r. Phase of rapid softening of the tendon ends.z, Phase ofincrease in ten"sile strength to a level which is reached on the sixteenth day.7 rI3. Further phase of increasing tensile strength which begins between the rgth andthe zrst day and which continues over a long period.Exposure of the tendon suture to traction is of special value in the third phase.If movement is allowed during the fi.rst two phases it produces excessive tissuereaction (more adhesions with the surrounding tissues) and suture dehiscense. Tractionon the tendon suture increases its tensile strength.Absolute rest during the first two weeks followed by limited movement duringthe next two weeks cause little tissue reaction and obtain a rapid increase in tensilestrength. In free tendon grafts the processes are analogous.ln Chapter 1ll the publications dealing with the treatment of flexor tendon lesions in thethumb and fingers are discussed, in so far as these relate to the lesions dealt with inthis paper.ln Chapter Iz the principles of flexor tendon grafts are discussed.Tendon suture within the sheath area results in complete adherence between thetendons themselves and with the surrounding tissues. There is no paratenon presentin the sheaths.For this reason, in tendon injuries in this area, only the profunclus tendon isreconstructed and that with a free tendon graft which is put in from the palm to theterminal phalanx. This gives two tendon sutures both of which are beyond the area ofthe sheath. Adhesions to the terminal phalanx or in the palm (origin of the lumbricalmuscle) wil l not cause serious l imitation of movement.The indications are thoroughly described.A short remark about primary ancl secondary tendon grafts finishes this chapter.ln Chapter VI the operative technique is discussed, making it clear that one tries tosimplify it as much as possible. The dressing technique and the after-treatment are alsodescribed.ln Chapter tr41 personal w<-rrk is discussed. It is first indicated how the results areevaluated. All cases are then discussed. At the end of the chapter this series is judgedby its results. 55 tendon grafts were carried out, 4r cases produced a good result,r4 cases were failures. From this it is clear that the operation is justif ied.The 14 failures are further explored: 6 of them had been previously operated.(Only 9 of the 4r good results had been previously operated).The time between injury and grafting varied from 4 weeks to 5 years. There is noclear relation between this time and the results obtained.(was IIrIrphalctechrIrindicIIworltend,folloreco'rssuertionrnngnsiler therh ines to: alsoi aredgedsult,andr theesentrn isr the'ea ofrricalpter.rted.Of the 14 failures it must be noted that in Cases I and V, a different techniquewas used.In Cases VI and XII pulleys were reconstructed without success.In Cases XI, XV and also XII a flexion contracture of 9oo at the proximal inter-phalangeal joint was noticed at the first redressing. This meant a fault in the dressingtechnique.In Cases XIV, XVI, XVII anil XXIV it is obvious on further examination that theindications for a tendon graft are not closely followed.In Cases XVIII and XLI the causes of failure are not clear.Although there are still many variable factors in this series which make a statisticalwork out impossible, it may be clinically concluded that the tendon graft in flexortendon injuries in the area of the sheaths in the thumb ánd fingers, properly done andfollowing the right indications, is a useful operation with which a satisfying functionalrecovery can be obtained.)rs no7 3

Vrije peestransplantatie bij de behandeling van buigpeesletsels aan duim en vingers.

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Vrije peestransplantatie bij de behandeling van buigpeesletsels aan duim en vingers.

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