Clinical Application of a Biological Membrane to Prevent Adhesions of Flexor Tendon Repair

This paper reports the clinical results of reconstructing flexor tendon sheath by a chemically treated absorbable semi-permeable polylactic membrane. This membrane was shown in previous experimental studies to be absorbed 24 weeks after operation and created a good pseudosynovial sheath for tendon gliding. Since January 1989, 80 cases (110 fingers) with flexor tendon lacerations in zone 2 were treated by this technique. These included 52 fingers with primary tendon repair and 58 fingers with free tendon grafts at secondary surgery. The biological membrane was used to repair the defect of the sheath in primary surgery, and in secondary tendon grafting the membrane was wrapped as a tube around the graft and fixed to the graft by suture at its distal end and to the A1 pulley in its proximal end. Controlled passive finger flexion using Kleinert rubber band fraction was commenced 3 days after surgery and active motion after 3 weeks. The cases were followed for 1 to 4 years. The results of repair were excellent in 29 fingers, good in 54, fair in 15, and poor in 3 by the TAM system. The rate of excellent and good results was 82.0%. One case of primary repair developed rupture of the repair due to wound infection.