Tenography has been performed on eight detached fingers and two intact hands of cadavers. Bulging and overlapping of synovial pockets between the ligamentous structures during flexion, their flattening during extension and the continuous change in expansion of the proximal cul de sac suggests a possible mixing mechanism for the synovial fluid. During flexion and extension a physiological joint-type bowstringing of the flexor tendons was observed at the PIP and DIP joints. This finding supports the theory that the flexor tendon moment arm is increased at these joints.

In his literary analysis, the author describes a novel method applied in the reconstruction of flexor tendon injuries of the hand. This procedure is named tissue engineering, and it is examined mainly under experimental circumstances. After definition of the method and descriptions of literary preliminaries the author discusses the healing process of the normal tendon tissue, then development of the scaffold, an important step of tissue engineering is described. After these topics the introduction of the pluripotent mesenchymal stem cells into the scaffold, and proliferation of these cells and development of the sliding systems are presented. The mechanical resisting ability of the formed tendon tissue is also discussed. Finally, the author concludes that as long as results of experimental research cannot be successfully applied into clinical practice, well-tried tendon reconstruction operations and high quality postoperative rehabilitation are needed.

The author summarizes the most important data about the development of reconstructive techniques of nerve injuries in the hand based on literature references and the author's own experience in the past decades. A new bulk of knowledge turned into a common property related to the micro- and macroanatomic structure of peripheral nerves, the process of nerve regeneration, and the technical conditions of nerve reconstructive operations. This knowledge is a prerequisite for hand surgeons to perform their nerve reconstructive operations on a contemporary high level with an optimal result. After a critical review of literature data, the author reports his own experience and sketches the coming possible roads. A detailed list of references is also provided for those who are interested in the field.

Reconstruction of the flexor tendon injuries is one of the most difficult problems in hand surgery, because the postoperative end-results are often unfavorable. The author discusses the history of the flexor tendon surgery, and then he describes the development of the knowledge regarding the anatomy, the blood supply and the tendon healing of the flexor tendons from the beginning until now. After that he describes the development in suture materials, suture techniques, primary and secondary tendon reconstruction operations, postoperative treatment and rehabilitation programmes. The author describes what kind of progress to be expected in this field in the near future, and then he expresses his viewpoint about the development in the international and national hand surgical societies. He encloses a detailed list of literature for those who are interested in the field.

For a long time in the clinical practice the autologous nerve transplants are used in reconstruction of the segmental defects of injured hand nerves. The published outcomes, especially in case of the motor and mixed (sensory and motor) nerves, however, were not satisfactory. Hence, it remained a problem and in the focus of research. The author aimed to study this topic and drawing conclusions in his literary review publication. According to the recent results, the replacement of the autologous nerve transplants with other materials (e.g. nerve conduits, various allografts, etc.) has shown good outcomes in mixed nerves too, if the distance of the resected nerve ends do not exceed 6 mm and the diameter of the nerves were not more than 3-7 mm. The applications of these methods have shown poor results, if the defect and/or the nerve diameter were larger. So, in these cases the autologous nerve transplantation remains the optimal management in the future. Orv Hetil. 2017; 158(30): 1163-1167.