The role of revascularization in the nutritional support of repair of
the flexor tendons is not completely understood. To explore the extent to
which intrasynovial flexor tendons revascularize after transection and
suture, a vascular injection study was carried out in a canine model. The
tendons to the second and fifth digits of the forepaw in twelve adult
mongrel dogs were transected and repaired. There were twenty-four
experimental tendons and twenty-four normal tendons. The limb was placed in
a polyurethane shoulder-spica cast, and the paw was treated with immediate
protected passive mobilization. At three, seven, ten, seventeen, and
twenty-eight days, the animals were killed and the major arteries supplying
both the paw that had been operated on (left) and the contralateral normal
paw (right) were injected with 200 milliliters of India ink. Segments of
repaired and normal tendons were then clarified by a modified Spalteholz
technique. The normal tendons demonstrated a well developed mesotenon that
provided vascularization of the proximal portion of the flexor digitorum
profundus tendon. A consistent three-cubic-millimeter avascular
intrasynovial portion of tendon was noted. Distally, vessels arose from the
vinculum breve, supplying the terminal twenty millimeters of tendon
substance. In the experimental tendons, longitudinal and transverse
clarified sections showed consistent revascularization of the site of
repair by proximal vessels in the absence of ingrowth of peripheral
adhesions. Vessels in the epitenon progressively extended for a distance of
ten millimeters, through normally avascular regions, to reach the site of
repair by the seventeenth postoperative day. Intratendinous vessels about
the site of repair consistently originated from surface vessels, rather
than from extensions of pre-existing intratendinous vessels. New vessels
penetrated all areas, including the normally avascular volar segments of
tendon, irrespective of previous topical zones of avascularity. Proximal
vascular plexi were characterized by large tortuous vessels with frequent
circuitous branches. More distal vessels had a longitudinally oriented,
feathery appearance.