Tags

Type your tag names separated by a space and hit enter

Flexor tendon grafts for pulley reconstruction - Morphological aspects.
Ann Anat. 2020 Jun 05; 231:151550.AA

Abstract

BACKGROUND

Pulleys are crucial to convert flexor tendon excursion into angular motion at the metacarpophalangeal and interphalangeal joints. Loss of pulley function can lead to significant impairment of hand function and may require surgical reconstruction. This reconstruction can be achieved using different flexor tendons grafts, such as the intrasynovial flexor digitorum superficialis (FDS) or the extrasynovial palmaris longus (PL). However, there is limited knowledge on the micromorphology of human pulleys and the suitability of flexor tendon grafts for their reconstruction remains elusive.

METHODS

In the present cadaver study A2 and A4 pulleys were compared with FDS and PL tendons by means of scanning electron microscopy (SEM), histology and immunohistochemistry. Surface morphology, core structure and vascularization of the specimens were analyzed.

RESULTS

SEM imaging of the gliding surfaces revealed morphological differences between tendons and pulleys. Moreover, the core structure of FDS samples was characterized by bundles of individual collagen fibrils whereas PL tendons exhibited a less hierarchical microstructure. In contrast, pulleys consisted of lamellar sheets of densely packed collagen fibrils. Finally, immunohistochemical analyses revealed that the flexor tendons and pulleys contain similar numbers of CD31+ microvessels, indicating a comparable tissue vascularization.

CONCLUSION

This study provides novel SEM and immunohistochemical insights into the micromorphology of human pulleys and flexor tendon grafts. Intrasynovial flexor tendons may be particularly suitable for pulley reconstruction and preserving the paratenon may be crucial for graft revascularization.

Authors+Show Affiliations

Institute for Clinic al and Experimental Surgery, Saarland University, Homburg/Saar, Germany; Department for Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg/Saar, Germany.Department of Hand and Plastic Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland.Department for Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg/Saar, Germany.Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, University of Zürich, Zürich, Switzerland.Saarland University Medical Center, Institute of Anatomy and Cell Biology, Homburg/Saar, Germany.Institute for Clinic al and Experimental Surgery, Saarland University, Homburg/Saar, Germany.Department for Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg/Saar, Germany.Institute for Clinic al and Experimental Surgery, Saarland University, Homburg/Saar, Germany; Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, University of Zürich, Zürich, Switzerland. Electronic address: florian.frueh@usz.ch.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32512200

Citation

Fritz, Tobias, et al. "Flexor Tendon Grafts for Pulley Reconstruction - Morphological Aspects." Annals of Anatomy = Anatomischer Anzeiger : Official Organ of the Anatomische Gesellschaft, vol. 231, 2020, p. 151550.
Fritz T, Ducommun P, Pohlemann T, et al. Flexor tendon grafts for pulley reconstruction - Morphological aspects. Ann Anat. 2020;231:151550.
Fritz, T., Ducommun, P., Pohlemann, T., Calcagni, M., Tschernig, T., Menger, M. D., Metzger, W., & Frueh, F. S. (2020). Flexor tendon grafts for pulley reconstruction - Morphological aspects. Annals of Anatomy = Anatomischer Anzeiger : Official Organ of the Anatomische Gesellschaft, 231, 151550. https://doi.org/10.1016/j.aanat.2020.151550
Fritz T, et al. Flexor Tendon Grafts for Pulley Reconstruction - Morphological Aspects. Ann Anat. 2020 Jun 5;231:151550. PubMed PMID: 32512200.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Flexor tendon grafts for pulley reconstruction - Morphological aspects. AU - Fritz,Tobias, AU - Ducommun,Pascal, AU - Pohlemann,Tim, AU - Calcagni,Maurizio, AU - Tschernig,Thomas, AU - Menger,Michael D, AU - Metzger,Wolfgang, AU - Frueh,Florian S, Y1 - 2020/06/05/ PY - 2020/04/17/received PY - 2020/05/13/revised PY - 2020/05/18/accepted PY - 2020/6/9/pubmed PY - 2020/6/9/medline PY - 2020/6/9/entrez KW - Flexor digitorum superficialis KW - Flexor tendon graft KW - Hand surgery KW - Palmaris longus KW - Pulley reconstruction KW - Pulley vascularization SP - 151550 EP - 151550 JF - Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft JO - Ann. Anat. VL - 231 N2 - BACKGROUND: Pulleys are crucial to convert flexor tendon excursion into angular motion at the metacarpophalangeal and interphalangeal joints. Loss of pulley function can lead to significant impairment of hand function and may require surgical reconstruction. This reconstruction can be achieved using different flexor tendons grafts, such as the intrasynovial flexor digitorum superficialis (FDS) or the extrasynovial palmaris longus (PL). However, there is limited knowledge on the micromorphology of human pulleys and the suitability of flexor tendon grafts for their reconstruction remains elusive. METHODS: In the present cadaver study A2 and A4 pulleys were compared with FDS and PL tendons by means of scanning electron microscopy (SEM), histology and immunohistochemistry. Surface morphology, core structure and vascularization of the specimens were analyzed. RESULTS: SEM imaging of the gliding surfaces revealed morphological differences between tendons and pulleys. Moreover, the core structure of FDS samples was characterized by bundles of individual collagen fibrils whereas PL tendons exhibited a less hierarchical microstructure. In contrast, pulleys consisted of lamellar sheets of densely packed collagen fibrils. Finally, immunohistochemical analyses revealed that the flexor tendons and pulleys contain similar numbers of CD31+ microvessels, indicating a comparable tissue vascularization. CONCLUSION: This study provides novel SEM and immunohistochemical insights into the micromorphology of human pulleys and flexor tendon grafts. Intrasynovial flexor tendons may be particularly suitable for pulley reconstruction and preserving the paratenon may be crucial for graft revascularization. SN - 1618-0402 UR - https://www.unboundmedicine.com/medline/citation/32512200/Flexor_tendon_grafts_for_pulley_reconstruction_-_Morphological_aspects L2 - https://linkinghub.elsevier.com/retrieve/pii/S0940-9602(20)30094-7 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.