Showing papers in "Archivum chirurgicum Neerlandicum in 1971"

Recent advances in flexor tendon repair.

Abstract: 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. In our department the number of patients sent for treatment who fulfil all the re­ quirements for the achievement of satisfactory results is relatively small compared with the number of patients who do not fulfil these requirements. Dissatisfaction with the results of treatment when we followed conventional proce­ dures in the latter group of patients and the conviction that a surgical result although poor by objective criteria may well be of importance when evaluated by subjective criteria (Fig. I) brought us to analyse our problems connected with tendon surgery in general and caused us to look for a possible solution to the problems we were faced with especially in the group of patients with a bad prognosis any way. Because the fact that good results are difficult to achieve in the treatment of tendon lesions is largely due to the process of healing, the following factors must be discussed: - the anatomy of the tendon, its blood supply and the tissues surrounding it, - the capacity for healing of these structures, - the possible methods of tendon repair.