CHAPTER III : HOW CAN THE SLIDING SYSTEM BE REPAIRED IN ONE OPERATING STAGE ?
How can the sliding system be repaired in one operating stage ?
SURGICAL COROLLARY
THE METHOD OF NATURAL REPLACEMENT for secondary flexor tendon salvage situations
This manner of understanding tendon physiology introduces a completely different way of confronting the problem of reconstruction :
- a) It emphasizes the tendon-sheat couple and the major role of tendon vascularization with peripheral collagen organization.
- b) It is inspired by biological considerations and involves THE TRANSFER OF A SLIDING UNIT COMPOSED OF A FLEXOR TENDON AND ITS SURRONDING SHEATHS IN REVERSE ISLAND PEDICLE MANNER IN ONE SINGLE OPERATION? THUS AVOIDING THE TWO-STAGE PROCEDURE FOR SECONDARY REPAIR.
This new technique is used today in clinical cases for the reconstruction of finger flexor systems in grades III and IV of BOYES' classification.
- Two basic principles
- 1°) The tendon can only be conceveid of as vascularized.
- 2°) The tendon can only only be conceveid of as an element in association with its surrounding sheaths to form a sliding unit.
To conform with these two basic principles, the new technique must satisfactorily answer three basic questions.