Fibroblast chemotaxis after tendon repair

Healing canine flexor tendons were treated with early controlled passive mobilization. The repair site and proximal and distal tendon stumps were stained for fibronectin and examined by light microscopy at three, seven, eleven, and seventeen days. Fibronectin increased dramatically in the epitenon adjacent to the repair site seven days after repair, a time when epitenon cellular activity was at its peak. By seventeen days, fibronectin staining had decreased substantially, both at the repair site and in the tendon stumps. A delayed increase in fibronectin activity was noted in the endotenon adjacent to the repair site. Fibronectin production appears to be an important component of the early tendon repair process. Fibroblast chemotaxis and adherence to the substratum in the days after injury and repair appears to be related directly to fibronectin secretion. This study is the first to provide documentation of fibronectin localization in a clinically relevant tendon repair model.     

The assessment of flexor tendon function after primary tendon repair

Because the actual methods of assessment and the grading of these methods in favor at any one time have changed so much over the last 50 years, the usefulness of the considerable experience in this field for practitioners today is much reduced. Agreement on the systems of assessment to be used for the different parts of the flexor system would allow a better exchange of knowledge worldwide at this time and a more useful cumulative experience for the next 50 years. If an acceptable method of assessment of any particular injury and its treatment can be agreed on by all, two stages remain for us to audit our work. The first is identifying how much we must downgrade the expectations of the assessment to accommodate the imperfections of our treatments. Most patients would consider an "excellent" result to be a return to normal. Currently, using, for example, the first Strickland system of assessment, we are happy to call any result of primary repair of a zone 2 flexor tendon division greater than 85% of normal, "excellent." How much we should reasonably downgrade our assessments is a variable that one hopes would reduce with accumulated experience, but one that makes repeated adjustment of our methods of assessment essential. Having set the level of the "excellent," "good," "fair," and "poor" qualifying bands relative to normal digital function, it only remains to take our measuring instruments out of their boxes and measure!     

指伸肌腱修复术后的早期控制下活动

目的 防治指伸肌腱修复术后因制动所致的并发症。方法 对15例Ⅴ～Ⅷ区指伸肌腱损伤修复术后设计活动支具，早期行控制下活动。结果 术后3—6个月随访，按TAM标准评定疗效，优良率100％，无1例发生肌腱断裂。结论 指伸肌腱修复术后早期行控制下活动，是防治术后并发症的有效方法。     

Achilles tendon repair with the plantaris tendon compared with repair using polyglycol threads.

Therapeutic results in 56 surgically treated patients with rupture of the Achilles tendon are presented. Results with repair using plantaris tendon and by suture of polyglycol threads are compared in 41 patients in a long-term followup study. Although 54 patients returned to their pre-accident physical activity, in all cases residual phenomena like calf atrophy, thickening of tendon, and tendon excursion were analyzed. The use of synthetic absorbable threads shortens the convalescence period. Covering the repair site with the fanned plantaris tendon seems to help to avoid painful adhesions with the skin.     

Heterotopic ossification after single-incision distal biceps tendon repair with an endobutton

Heterotopic ossification is rarely encountered following repair of a distal biceps tendon by an anterior approach. Although much less common than with a classic two-incision approach, a review of the literature demonstrates that heterotopic ossification may still occur following anterior single incision techniques. We describe only the second reported case to our knowledge of symptomatic heterotopic ossification following repair of a distal biceps tendon rupture with an EndoButton.     

Residual tracheal pouch after repair of tracheaoesophageal fistula: endoscopic KTP laser treatment

There is usually a small pouch within the trachea after ligation and division of a tracheoesophageal fistula. Most are asymptomatic, but some present with cough or by causing problems with endotracheal or tracheostomy tubes. Repeated open transthoracic surgery to ligate the fistula closer to the tracheal wall is problematic because the pouch is within the wall itself. We have found that bronchoscopic treatment with the potassium (K) Titanyl Phosphate laser to divide the party wall provides a quick and effective way to deal with the pouch, and we present a series of four cases to illustrate this technique.     

指屈肌腱修复后早期主动活动防止粘连

指屈肌腱损伤是一种常见损伤,修复后常产生不同程度的粘连,阻碍肌腱的滑动,从而影响手指功能.肌腱粘连发生后常需施行松解术,目前早期控制性主、被动活动是一种有效的防止术后肌腱粘连的方法.     

屈指肌腱术后早期活动与康复

目的 探讨屈批肌腱修复术后早期功能锻炼的方法与意义。方法 对116例（286指）无合并骨折的屈指肌腱断裂给予修复,术后3日起开始被动屈曲并以辅以主动伸指练习,幅度循序渐进,4周后开始非辅助性训练,并依次给予音频、超短波及蜡疗等理疗;出院后每周随访1次,继续指导患者功能锻炼。结果 随访97例（249指）,时间6－18个月,采用TAM评定患指功能,优192指（77．1％）,良25指（10．0％）,可15指（6．0％）,差17指（6．8％）。结论 腱周粘连在肌腱修复过程中不可避免,早期活动促进形成非限制性粘连,增加修复腱在腱鞘内滑动度,早期恢复腱强度;早期活动宜从术后第3天开始。     

An inducement to exercise after flexor tendon repair

A simple gadget is described which provides the encouragement necessary for children to exercise in dynamic traction following flexor tendon repair in the hand. Its use has made possible the incorporation of dynamic splinting into the aftercare of very young patients.     

Early protected motion after extensor tendon repair.

Thirty hands with 50 extensor tendon lacerations, excluding mallet finger injuries, were examined. They were treated with surgical repair followed by immediate motion which included a dynamic splinting and tendon mobilization program. The average follow-up period was 7 months (range, 8 weeks to 2 years). Forty-five of the 50 tendons regained full range of motion (average total active motion, 262 degrees) within an average time of 9 weeks; the remaining 5 tendons had extension lags of < or = 10 degrees. All patients regained at least 93% of their predicted normal strength within 9 to 12 weeks and returned to their previous level of activity in an average of 10 weeks. These results, which include complex lacerations, are an improvement from previously published data. This is probably due to the addition of a tendon mobilization program to dynamic splinting following extensor tendon repair.     

Tissue substance P levels in acute experimental burns

PURPOSE OF STUDY: To determine the tissue concentrations of substance P (SP) in burns of different depths and to see whether the concentrations of SP relate to the previously reported late increase in tissue histamine concentrations. MATERIALS AND METHODS: Experimental animal study with pigs. Superficial, partial thickness and full thickness burns were created and the microdialysis method used to collect samples for substance P analysis from burned and non-burned control tissue during a 24-h follow-up. RESULTS: Substance P concentrations increase after 4h in the partial and full thickness burns reaching the peak at 18 and 12h, respectively. The increase was later and more modest in the superficial and control sites. At 24h the SP median concentrations in the superficial, partial and full thickness burns were 28%, 85% and 140% higher than in the control site, respectively. There was a peak in the SP concentration in serum at 4h followed by a decrease and stabilization at a level about 15 pg/ml. CONCLUSIONS: The release of substance P in tissue is a possible cause of the late increase in tissue histamine in burns. Medical inhibition of SP is of clinical interest in preventing late histamine liberation in burns.     

屈指肌腱修复术后弹性橡皮条制动疗效观察

目的 探讨58例Ⅱ区屈指肌腱离断修复术后用弹性橡皮条动力性制动的疗效。方法 离断肌腱用改良Kessler法修复，于指甲末端用丝线缝合连接橡皮条。前臂至指端用背侧石膏托固定。橡皮条固定于前臂下段掌侧，使手指指间关节屈曲。术后48h开始行主动伸指，依靠弹性橡皮条作被动屈指练习3周。结果 随访3～6个月，手指伸屈功能正常。结论 屈指肌腱吻合术后用弹性橡皮条制动疗效佳。     

Serum levels of Hsp 72 measured early after trauma correlate with survival

BACKGROUND: Experimental studies have shown that hemorrhagic shock is associated with the expression of inducible heat proteins, especially heat shock protein (Hsp) 72, in liver, brain, heart, and kidney. Moreover, induction of Hsp 72 by various stressors before the onset of shock has been associated with the attenuation of organ injury caused by hemorrhage. However, it is not known whether Hsp 72 is expressed after severe trauma in humans. The purpose of this study was therefore to determine whether Hsp 72 could be detected in the serum of patients early after severe trauma and whether serum levels of Hsp 72 might correlate with survival of trauma patients or the severity of the postinjury inflammatory response. METHODS: Clinical data were collected prospectively over a 3-year period for trauma patients mechanically ventilated for more than 2 days who met the following inclusion criteria: Injury Severity Score > or = 16, and age > 18 years. Physiologic data for quantitative assessment of organ dysfunction were collected for each patient. Hsp 72 and nitrate and nitrite levels were measured in the serum of trauma patients collected at or 12 to 48 hours after the admission to the emergency department. RESULTS: Sixty-seven patients with severe trauma were enrolled in the study. Hsp 72 was detected in the serum of all trauma patients. All patients with high initial serum levels of Hsp 72 (serum levels > 15 ng/mL) survived, whereas 29% of the patients with low Hsp 72 serum levels died from their traumatic injuries (p = 0.01). The overall mortality was 21%, occurring within 5 to 7 days. Patients who died were older (mean age, 54 +/- 15 years) than those who survived (mean age, 36 +/- 15 years) (p < 0.0.05). The cause of death was attributable to head injury in 79%, although the severity of head injury (Abbreviated Injury Scale score) was not statistically different between survivors with high serum values of Hsp 72 and patients who died. There was no correlation between the initial serum Hsp 72 values and the severity of organ dysfunction or clinical indicators of the inflammatory response. CONCLUSION: Hsp 72 can be detected in the serum of severely traumatized patients within 30 minutes after injury. Elevated initial serum levels of Hsp 72 (serum levels > 15 ng/mL) are associated with survival after severe trauma, but are not related to the incidence or severity of the postinjury inflammatory response or organ dysfunction.     

Surface modification counteracts adverse effects associated with immobilization after flexor tendon repair

Although post‐rehabilitation is routinely performed following flexor tendon repair, in some clinical scenarios post‐rehabilitation must be delayed. We investigated modification of the tendon surface using carbodiimide derivatized hyaluronic acid and lubricin (cd‐HA‐Lub) to maintain gliding function following flexor tendon repair with postoperative immobilization in a in vivo canine model. Flexor digitorum profundus tendons from the 2nd and 5th digits of one forepaw of six dogs were transected and repaired. One tendon in each paw was treated with cd‐HA‐Lub; the other repaired tendon was not treated. Following tendon repair, a forearm cast was applied to fully immobilize the operated forelimb for 10 days, after which the animals were euthanized. Digit normalized work of flexion (nWOF) and tendon gliding resistance were assessed. The nWOF of the FDP tendons treated with cd‐HA‐Lub was significantly lower than the nWOF of the untreated tendons (p < 0.01). The gliding resistance of cd‐HA‐Lub treated tendons was also significantly lower than that of the untreated tendons (p < 0.05). Surface treatment with cd‐HA‐Lub following flexor tendon repair provides an opportunity to improve outcomes for patients in whom the post‐operative therapy must be delayed after flexor tendon repair. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:1940–1944, 2012