The Blood Supply of the Flexor and Extensor Tendons of the Fingers in Man

Abstract

The present investigation was inspired by a desire to know something about the factors that produce stiffness of the fingers after injury or inflammation. It seemed logical to inquire whether there were any vascular changes in the fingers in these circumstances, first because in any reaction of a tissue to injury the blood supply is affected, and secondly because fingers that are stiff often undergo so-called trophic changes which may well be related to impairment of blood supply. Before a study of disease processes could be carried out it was necessary to determine the normal vascular patterns of the tendons and joints of the fingers, more especially as the accounts in the literature are incomplete and sometimes contradictory. This paper deals with the normal blood supply of the tendons and tendon sheaths in man. It is intended in a second paper to describe the changes found in disease and after injury. Historical note-It was long considered that tendons were avascular structures, and today the opinion of K#{246}lliker (1850) is still repeated-that tendons have no blood supply. Ludwig and Schweigger-Seidel (1872) showed that intratendinous vessels existed, as did Mayer (1916). Mayer was chiefly interested in the operative surgery of tendons and gave only limited information about the blood vessels. But he did point out that tendons may receive blood vessels in four regions : 1) at the musculo-tendinous junction ; 2) at the osteo-tendinous attachment ; 3) in extra-synovial regions through the loose tissue surrounding the tendon (paratenon) ; and 4) in synovial regions through mesenteric attachments or synovial bands At this stage the veins were obstructed by a rubber band and the injection continued for three to four hours to obtain maximal filling of the vessels. Arteries, capillaries and veins were all filled by this technique. The material was dissected, fixed in 10 per cent formalin, developed photographically and then cleared in oil of wintergreen. An alternative method was the injection of Indian ink in plasma. Retrograde venous injection was found to be impracticable because of the presence of valves in the venous system. OBSERVATIONS The feeding vessels of the tendons. Non-synovial regions-Blood vessels reach the tendons in different ways in different parts of the hands and fingers. The simplest arrangement is VOL.

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“…Vessels are generally arranged longitudinally within the tendon, passing around the collagen fibre bundles in the endotenon, a sheet of loose connective tissue contiguous with the external layer or epitenon [20,31,32] (Fig. 1).…”

The Reverse Digital Artery Island Flap: An Update

“…[3][4][5][6] In particular, abundant vascular communications in the pulp of the distal phalanx exist, and these communications enabled the reverse digital artery island flap with more distally skeletonized pedicle to gain its retrograde blood supply without any trouble. However, in cases with soft-tissue injuries invading proximally beyond the center of the fingerprint, we stop the digital artery dissection approximately 5 mm proximal to the digital interphalangeal joint as in the previous publication, because we are not confident of achieving sufficient arterial anastomoses.…”

The Mature Athlete

“…Tendons receive vascular supply through the musculotendinous junction, the osseotendinous junction, and the vessels from the various surrounding tissues including the paratenon, mesotenon, and vincula. 2,24,27,102 Tendons in different areas of the body receive different amounts of blood supply. The vascular supply of the specific tendon also relates to whether or not it is a sheathed tendon.…”