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Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Tendon Vascular Supply and Nutrition


- Discussion:
    - tendons have limited blood supply;
    - each tendon receives its vascular supply from segmental vessels arising from surrounding peritenon & extending from forearm to midportion of the proximal phalanx;
    - in digits, however, blood supply reaches flexor tendons thru vincula;
    - these are folds of mesotenon thru which run the small vessels that penetrate the tendons;
    - one short and one long vinculum supply each FDS & FDP tendon;
    - vincula receive their blood vessels thru transverse communicating branches of the common digital artery located on the dorsal surface of  flexor tendons;
    - vincula provide blood supply that participates in early healing of flexor tendons and that also serves as a checkrein to limit proximal retraction of a lacerated tendon;

- Two Forms of Tendon Healing may occur:
    - intrinsic healing occurs without direct blood flow to the tendon;
          - animal models demonstrate that diffusion of synovial fluid around lacerated tendons allows intrinsic tendon healing without adhesion formation;
    - extrinsic healing is known to occur by proliferation of fibroblasts from the peripheral epitendon;
           - fibrous proliferation froms tenoma around the periphery of cut tendon ends and also invades space between tendon ends;
           - adhesions occur because of extrinsic healing of the tendon and limit tendon gliding within fibrous synovial sheaths


The contents of macromolecule solutes in flexor tendon sheath fluid and their relation to synovial fluid. A quantitative analysis.

The role of the synovial fluid and tendon sheath for flexor tendon nutrition. An experimental tracer study on diffusional pathways in dogs.

Microstructure of tendon and its clinical significance

Flexor tendon physiology: tendon nutrition and cellular activity in injury and repair

Experimental flexor tendon healing without adhesion formation--a new concept of tendon nutrition and intrinsic healing mechanisms. A preliminary report.

The healing of freeze-dried rabbit flexor tendon in a synovial fluid environment. 

The synovial cavity as a "tissue culture in situ"--science or nonsense?

Role of synovial fluid cells in the healing of flexor tendons.

Experimental studies on cellular mechanisms involved in healing of animal and human flexor tendon in synovial environment.

Biologic Aspects of Flexor Tendon Laceration and Repair

Blood supply of the flexor digital tendon in the hand and its clinical significance 

The vasculature and its role in the damaged and healing tendon.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, December 21, 2012 2:28 pm