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Construction of artificial tendon sheaths in dogs
Construction SANFORD
of Artificial Tendon in Dogs
H. ANZEL, M.D., PAUL R.LIPSCOMB,
Sheaths
M.D. AND JOHN H. GRINDLAY, M.D.,
Rochester, Minnesota
From tbe Mayo M’annesota.
Clinic and Mayo Foundation,
free tendon grafts and simple tendon sutures. The inverted venous tubes were sutured to tendons above and beIow the anastomoses. 2. This resembled the first procedure, but the inverted vein was sectioned IongitudinaIIy as weI1, and was then sutured IooseIy together. This method re-estabrished the venous tube with openings between sutures. 3. One and a half inches of tendon was stripped of paratenon and peritenon. It was then scarified with a scaIpe1. The inverted vein was then Iaid over a tendon as in the second procedure and was sutured to the tendon above and beIow the traumatized area. There were eight controIs for this group. In these the same operative procedure was performed on the opposite foreIeg, but no vein was used. Group 2. In this group of six dogs, tweIve extremities were operated upon. A rectanguIar piece of periosteum of the radius was excised. Three diagona1 incisions were made on the exposed anterior radial cortex with a Stryker saw. The previously removed vein graft was incised and laid open over the incisions in the bone, with the intima facing away from bone. The vein was sutured to the periosteum and the tendon (extensor carpi radiaIis longus) then gIided over the intima in the normal course of the tendon on the radius. The opposite foreIeg was used as a contro1.
Rochester,
designed to Iimit postoperative peritendinous adhesions are of two genera1 categories : (I) creation of a tunneI by a tubular moId, thereby providing a gliding surface for the tendon after the moId is removed, or (2) ensheathment of the tendon with a substance that prevents adhesions between tendon and surrounding tissue during healing. We investigated the Iatter procedure and used autoIogous vein grafts in dogs as artificia1 tendon sheaths to evaIuate the method as a means of preventing peritendinous adhesions at and about sites of fracture.
I
NVESTIGATIVE procedures
MATERIALSANDMETHODS
Seventeen dogs which weighed between IO and 12 kg. underwent operations on a tota of twenty-nine Iimbs. Fourteen of these were contro1 Iimbs. The dogs were kiIIed at intervaIs of twenty to I12 days. The extensor carpi radiaIis tendon was used for a11procedures. This tendon is surrounded by paratenon, but also has a true sheath in its dista1 portion where it lies under the abductor poIIicis Iongus tendon. AI1 vein grafts were obtained at the time of operation from one of the juguIar veins of the same dog. A segment one and a half inches Iong was removed. AI1 tendon and vein sutures were sutured with No. 5-o bIack siIk. BunneII’s technic and needIes were used for the tendon Fixation was achieved with anastomoses. Kirschner wires or plaster casts or both. Two groups of animaIs were used. Group I. In this group of eIeven dogs, seventeen extremities were operated upon. The folIowing procedures were performed. I. An inverted vein graft was sIipped over
RESULTS AND CONCLUSIONS
PIacement of an inverted encircIing vein graft over a tendon graft or anastomosis resuIted in severa observations and concIusions. AI1 the tendons were devitaIized to some degree, but this was not related to the type of procedure. AI1 the vein grafts fragmented and some 355
American Journal of Surgery.
Volume IOI. March 1961
AnzeI,
Lipscomb
became unrecognizabIe as veins. Fibrous-tissue reaction generally was greater when a vein was pIaced around the tendons than it was in the controk. ResuIts of this study and studies of other recent investigators suggest that paratenon and peritenon are responsibIe for tendon heaIing.
and
GrindIay
Autologous venous tissue served as a membrane barrier when pIaced over a site of fracture. With the venous intimal surface placed toward an adjacent tendon, this materia1 served as a smooth gIiding surface and prevented encroachment of bone and fibrous tissue on the tendon.
356
of Artificial Tendon in Dogs
H. ANZEL, M.D., PAUL R.LIPSCOMB,
Sheaths
M.D. AND JOHN H. GRINDLAY, M.D.,
Rochester, Minnesota
From tbe Mayo M’annesota.
Clinic and Mayo Foundation,
free tendon grafts and simple tendon sutures. The inverted venous tubes were sutured to tendons above and beIow the anastomoses. 2. This resembled the first procedure, but the inverted vein was sectioned IongitudinaIIy as weI1, and was then sutured IooseIy together. This method re-estabrished the venous tube with openings between sutures. 3. One and a half inches of tendon was stripped of paratenon and peritenon. It was then scarified with a scaIpe1. The inverted vein was then Iaid over a tendon as in the second procedure and was sutured to the tendon above and beIow the traumatized area. There were eight controIs for this group. In these the same operative procedure was performed on the opposite foreIeg, but no vein was used. Group 2. In this group of six dogs, tweIve extremities were operated upon. A rectanguIar piece of periosteum of the radius was excised. Three diagona1 incisions were made on the exposed anterior radial cortex with a Stryker saw. The previously removed vein graft was incised and laid open over the incisions in the bone, with the intima facing away from bone. The vein was sutured to the periosteum and the tendon (extensor carpi radiaIis longus) then gIided over the intima in the normal course of the tendon on the radius. The opposite foreIeg was used as a contro1.
Rochester,
designed to Iimit postoperative peritendinous adhesions are of two genera1 categories : (I) creation of a tunneI by a tubular moId, thereby providing a gliding surface for the tendon after the moId is removed, or (2) ensheathment of the tendon with a substance that prevents adhesions between tendon and surrounding tissue during healing. We investigated the Iatter procedure and used autoIogous vein grafts in dogs as artificia1 tendon sheaths to evaIuate the method as a means of preventing peritendinous adhesions at and about sites of fracture.
I
NVESTIGATIVE procedures
MATERIALSANDMETHODS
Seventeen dogs which weighed between IO and 12 kg. underwent operations on a tota of twenty-nine Iimbs. Fourteen of these were contro1 Iimbs. The dogs were kiIIed at intervaIs of twenty to I12 days. The extensor carpi radiaIis tendon was used for a11procedures. This tendon is surrounded by paratenon, but also has a true sheath in its dista1 portion where it lies under the abductor poIIicis Iongus tendon. AI1 vein grafts were obtained at the time of operation from one of the juguIar veins of the same dog. A segment one and a half inches Iong was removed. AI1 tendon and vein sutures were sutured with No. 5-o bIack siIk. BunneII’s technic and needIes were used for the tendon Fixation was achieved with anastomoses. Kirschner wires or plaster casts or both. Two groups of animaIs were used. Group I. In this group of eIeven dogs, seventeen extremities were operated upon. The folIowing procedures were performed. I. An inverted vein graft was sIipped over
RESULTS AND CONCLUSIONS
PIacement of an inverted encircIing vein graft over a tendon graft or anastomosis resuIted in severa observations and concIusions. AI1 the tendons were devitaIized to some degree, but this was not related to the type of procedure. AI1 the vein grafts fragmented and some 355
American Journal of Surgery.
Volume IOI. March 1961
AnzeI,
Lipscomb
became unrecognizabIe as veins. Fibrous-tissue reaction generally was greater when a vein was pIaced around the tendons than it was in the controk. ResuIts of this study and studies of other recent investigators suggest that paratenon and peritenon are responsibIe for tendon heaIing.
and
GrindIay
Autologous venous tissue served as a membrane barrier when pIaced over a site of fracture. With the venous intimal surface placed toward an adjacent tendon, this materia1 served as a smooth gIiding surface and prevented encroachment of bone and fibrous tissue on the tendon.
356