1. T en on
healing variables
repair
grafting
mansoor khan
August, 2010
HMC Plastic
& reconstruction
d

2. muscle to the bone
glistening structure
between muscle
& bone which
transmit force from
“
”

3. collagen
fibrils
fibers
fasciles
tertiary bundles
Tendons
endotenon
histology of tendons

5. Paratenon

8. Double layer, outer fibrous & inner synovial
Synovial layer is parietal and visceral
containing synovial fluid
tendon sheath

9. B
L
O
O
D
vessels from musculotendonous
junctions Vessels 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 & tendon graft healing
clot and fibrin plug
seals the tendon gap
macrophages/neutroph
ils appears
Stitch provide the
whole strength

12. cells migrate into the 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 shifted to
the scar gradually
Tendon & tendon graft healing

14. Idea of tendon’s incapability 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
hyluronic acid improves healing

16. Indications: Lacerations with
intact soft tissue, Digital re-
implantation,
Tendon laceration with
fractured bones
Goals: Tendon
healing, effortless
gliding, full joint
motion

17. mobile digit with minimal scare
at least one digital nerve intact
meticulous surgical technique
co-operative patient
careful graduated mobalization

22. Increases healing, collagen deposition
and remodelling, pumping of nutrients
inside the tendon, disruption of early
vascular budding & adhesions frmation

23. strength P roportional
number
strands

25. Eight strand
Kessler repair
Four strand
cruciate
VS

26. Four strand
cruciate
light with composite grip easy to
perform, knots outside, similar
time as kessler and stronger

27. tendo n
g rafting

28. When tendon ends can’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
adherent extensor tendons
planned capsulotomy

34. ten
lengt
tech
tendon
lengthening
techniques
tendon
don
hening
niques
tendon
Lengthening/shotening
techniques

40. Z- incision & resectionfor shortening

41. Doubling technique

42. Hoffa’s method