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Tendon
This document discusses tendon healing and repair techniques. It covers the histology of tendons, the tendon healing process, and various techniques for tendon repair including suturing methods and tendon grafting. Key points include that both intrinsic and extrinsic healing contribute to tendon repair, and techniques like controlled motion help promote healing while preventing adhesions. Suturing methods like the Kessler and cruciate repairs are discussed and compared. Tendon grafting indications and requirements are also outlined.
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Tendon
- 1. T en on healingvariables repair grafting mansoor khan August, 2010 HMC Plastic & reconstruction d
- 2. muscle to thebone glistening structure between muscle & bone which transmit force from “ ”
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- 8. Double layer, outerfibrous & inner synovial Synovial layer is parietal and visceral containing synovial fluid tendon sheath
- 9. B L O O D vessels from musculotendonous junctionsVessels from osseotendonous junctions vanicula (briva & longa) in compression areas (joints), loose areolar tissue vessels (non-compression areas) s u p p l y
- 11. Tendon & tendongraft healing clot and fibrin plug seals the tendon gap macrophages/neutroph ils appears Stitch provide the whole strength
- 12. cells migrate intothe wound from, peritenon (extrinsic healing), epitenon/endotenon/tenocytes (intrisic healing) Becomes fibroblasts produce collagen Tendon & tendon graft healing Stitch provide the whole strength
- 13. Strength is shiftedto the scar gradually Tendon & tendon graft healing
- 14. Idea of tendon’sincapability of intrinsic healing leading to extrinsic healing and adhesions formation CHANGED Both intrinsic & extrinsic healing are responsible but we have to minimize extrinsic healing to prevent adhesions
- 15. Tendon healing modulators hyluronicacid improves healing
- 16. Indications: Lacerations with intactsoft tissue, Digital re- implantation, Tendon laceration with fractured bones Goals: Tendon healing, effortless gliding, full joint motion
- 17. mobile digit withminimal scare at least one digital nerve intact meticulous surgical technique co-operative patient careful graduated mobalization
- 22. Increases healing, collagendeposition and remodelling, pumping of nutrients inside the tendon, disruption of early vascular budding & adhesions frmation
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- 25. Eight strand Kessler repair Fourstrand cruciate VS
- 26. Four strand cruciate light withcomposite grip easy to perform, knots outside, similar time as kessler and stronger
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- 28. When tendon endscan’t be approximated Necrotic stump Indications Complete wound healing with adequate soft tissue coverage Absent edema/induration Satisfactory & stable Skeletal alignment Full range of passive motion of joint Requirements
- 29. absence of indications adherentextensor tendons planned capsulotomy
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- 40. Z- incision &resectionfor shortening
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