[Historical development of surgery of the flexor tendons].

Abstract

The author describes the evolution of ideas, which have resulted from the different concepts on the healing process of flexor tendons in the digital sheath. Two theories have been held in opposition since the middle of the nineteenth century: intrinsic axial healing after Paget (1814-1899) and extrinsic peripheral healing after Adams (1920-1900). These two theories are still supported by good arguments. Research on animals and anatomical studies on man have shown with great exactitude the route of vascularization of flexor tendons, especially through the mesotenons and vincula and also that synovial fluid is not only a lubricant but also a nutritional environment, in the same way as the synovial fluid in a joint (Lundborg). This fluid plays an important role in the endosynovial healing of sutured tendons provided that the sheath is maintained intact. To limit adhesions to a minimum after endosynovial tendon suture, one must try to follow three basic principles: I. Preservation of the vessels of the tendons II. Early mobilization III. Closure of the synovial sheath.