Abstract
Traditional single- and two-stage tendon grafting methods for flexor tendon reconstruction have been unable toconsistently restore satisfactory digital flexion. Although multiple factors may affect the ultimate outcome, the role of the donor tendon graft has only recently been examined. Current methods of flexor tendon grafting for failed zone II tendon repairs and neglected flexor tendon lacerations involve the use of extrasynovial donor grafts. Clinical and histological studies have shown significant adhesion formation as a result of early cellular necrosis and peritendinous tissue ingrowth into the extrasynovial donor graft. The formation of these adhesions may result in poor tendon excursion and limited proximal interphalangeal joint rotation. Recent studies have shown that intrasynovial donor tendon grafts are incorporated to the native tendon site by a unique intrinsic mechanism of repair. Improved functional characteristics of increased tendon excursion and increased digital rotation are primarily caused by this paucity of adhesion formation and will hopefully result in improved overall patient outcomes.
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