ANGIOGENESIS IN HEALING AUTOGENOUS FLEXOR-TENDON GRAFTS

On the basis of recent evidence that flexor tendon grafts may heal without the ingrowth of vascular adhesions, eighteen autogenous donor tendons of intrasynovial and extrasynovial origin were transferred to the synovial sheaths in the forepaws of nine dogs, and controlled passive mobilization was instituted early in the postoperative period. The angiogenic responses of the tendon grafts were determined with perfusion studies with India ink followed by cleaing of the tissues with the Spalteholz technique at two, four, and six weeks. A consistent pattern of neovascularization was noted in the donor tendons of extrasynovial origin. Vascular adhesions arising from the flexor digitorum superficialis and the tendon sheath enveloped the tendon grafts by two weeks. By six weeks, the vascularity of the tendon grafts of extrasynovial origin appeared completely integrated with that of the surrounding tissues. Examination of cross sections revealed that the segments of tendon had been completely vascularized by obliquely oriented intratendinous vessels. In contrast, the flexor tendon grafts of intrasynovial origin healed without ingrowth of vascular adhesions. Primary intrinsic neovascularization took place from the proximal and, to a lesser extent, distal sites of the sutures. Examination of cross sections revealed vessels extending through the surface layer of the tendon graft, with small vessels penetrating the interior of the tendons at regular intervals. CLINICAL RELEVANCE: We believe that this is the first study to demonstrate a distinction between the angiogenic responses of flexor tendon grafts of intrasynovial and extrasynovial origin in a clinically relevant tendon-graft model. These data suggest that donor tendon grafts of intrasynovial origin may become incorporated without the formation of adhesions or the development of avascular necrosis. Thus, there is a potential for improved digital function when tendon grafts of similar anatomical and functional origin to the replaced tendon are used.