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Journal of the Korean Society for Surgery of the Hand 1997;2(1):16-27.
Published online January 1, 1997.
Fibrin Sealant in The Management of Flexor Tendon Injury An Experimental Study of the Chicken
Jun O Yoon,Jung Jae Kim,Sung Jin Cho,Jong Hi Park
Fibrin 잡착제를 이용한 굴곡건 손상의 치료 - 닭을 이용한 실험적 연구 -
Despite extensive research into the biology of tendon healing, predictably restoring normal function of digit after a flexor tendon laceration remains one of the most difficult problems. Torn tendon should be healed with fibrous tissue strongly enough to gain the motion of digit, while peritendinous scar should be minimized for avoiding adhesion and smooth gliding motion. Several kinds of approaches have been accomplished to improve final outcome with remarkable success, and they are microsurgical technique, postoperative controlled mobilization, attempts at replacing the tendon sheath and many biochemical trials suppressing inflammatory adhesion. The experiment is focussed on the etTect of tissue glue, two component tibrin sealant coated at the repair site of flexor tendon. It has been used for the prevention of peritoneal adhesions, in tubal fertility surgery and nerve repair. Its effectiveness was proved, but there is few proof for its usefulness in tendon surgery. The hypothesis is that the fibrin sealant will not only provide smooth serosal surface and mechanical strength, but prevent further adhesion. The aim of the experiment is to prove this hypothesis using histopathologic method. In the central toes of 20 chickens, laceration of profundus tendon were repaired with core stitch. Right side tendons were coated with fibrin sealant and left ones were not treated with fibrin sealant as the control group for each chicken. Constrained passive motion was allowed postoperatively. Chickens were sacrificed at postoperative 3 day, 1, 2, 4, 6 and 8 weeks. Histopathologic study was done for 32 tendons(experiment group : 17, control group : 15). Between the two groups, there was no difference in tendon healing(P>0.05) and quantitative degree of adhesion(P>0.05) after more than 4 weeks postoperatively. But the degree of adhesion in the qualitative aspect was much less degree in the fibrin sealant group compared with the control group (P<0.05). Fibrin sealant is proved to prevent peritendinous adhesion, but does not affect tendon healing. Further biomechanical test to confirm its effect on the functional therapeutic result will be needed.
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