Digital Oedema, Adhesion Formation and Resistance to Digital Motion after Primary Flexor Tendon Repair

Abstract

The development of digital oedema, adhesion formation, and resistance to digital motion at days 0, 3, 5, 7, 9 and 14 after primary flexor tendon repairs using 102 long toes of 51 Leghorn chickens was studied. Oedema presented as tissue swelling from days 3 to 7, which peaked at day 3. After day 7, oedema was manifest as hardening of subcutaneous tissue. The degree of digital swelling correlated with the resistance to tendon motion between days 3 and 7. At day 9, granulation tissues were observed around the tendon and loose adhesions were observed at day 14. Resistance to digital motion increased significantly from day 0 to day 3, but did not increase between days 3 and 9. The early postoperative changes appear to have three stages: initial (days 0-3, increasing resistance with development of oedema), delayed (days 4-7, higher resistance with continuing oedema) and late (after day 7-9, hardening of subcutaneous tissue with development of adhesions).

Biomechanical comparisons of four-strand tendon repairs with double-stranded sutures: effects of different locks and suture geometry

“…Soft tissue oedema, the presence of flexor pulleys and adhesion formation would all contribute to resistance to tendon motion and thus influence tendon strength (Cao and Tang, 2009;Cao et al, 2008;Zhao et al, 2004).…”

Molecular Events of Cellular Apoptosis and Proliferation in the Early Tendon Healing Period

“…The chickens, weighing 1.5 to 2.5 kg each, were used as experimental models because they have a flexor mechanism similar to that of human digits and are a common model for studying the digital flexor tendon. [21][22][23][24][25][26] The chickens were anesthetized with an intramuscular injection of ketamine (50 mg/kg body weight).…”

The Effects of Edema and Self-adherent Wrap on the Work of Flexion in a Cadaveric Hand

“…18 -20 Cao demonstrated that the severity of postoperative edema is proportional to the increases in work needed to flex chicken digits. 19 The timing of the effects of edema has also been characterized, 20 including an early, substantial increase in resistance to digital motion; an intermediate period of higher resistance but no further increase in resistance; and a late period, characterized by the formation of adhesions. The results of these studies have led to recommendations regarding the most appropriate time to begin postoperative therapy.…”