The restoration of function to a hand with adherent or destroyed flexor tendons and tendon sheaths is difficult and often unsatisfactory. Foreign materials, used to form a sheath or to prevent adhesions, have not been found satisfactory. In the finger there is not room for a free transplant of paratendinous fat which has been used with success in other locations.
For the reconstruction of a tendon sheath, tunica vaginalis is superior to other tissues which have been used. Histologically and functionally it resembles the thin, secreting membrane which normally encloses the flexor tendons of the fingers. Early motion is as essential as careful suturing in the reconstruction of flexor tendons and tendon sheaths.