Preventing adhesions after flexor tendon repair

• Injury (including surgery)
  • breaches cell basement membrane
  • sparks inflammatory response
• Interaction between inflammatory response, coagulation cascade, and angiogenesis
• Hypoxia drives fibroblast differentiation to adhesion phenotype fibroblasts

• besides tendons also important in abdominal, intrauterine, pericardial surgery
• disruption of epithelial or mesothelial layer leads to fibrin adhesions due to
  • downregulation of fibrinolytic activity
  • increase in fibrin deposition
• key metabolic activities affecting adhesions: tissue healing, coagulation, inflammation, fibrinolysis, angiogenesis

• Mechanical barriers
• Anti-adhesive agents
• Combination
• Others: e.g. gene therapy

• Heparin
• Hyaluronic acid
• Rhy

• Chemokines
• Protein c anticoagulation pathway
• Fibrinolytic pathway

• Fibrin clot forms scaffold for deposition of organized matrix and then adhesions
• M1 (pro) vs M2 (anti) macrophages

• Surgical technique e.g AT, Kessler
• Barriers: polymer – natural (HA, gelatin, collagen) and synthetic (PLA, PEG), tissue grafts (allogeneic amniotic membranes)
• Commercial: hyaloglide, adcon gel, tenoglide
• Other Adjuvants
  • Fibrinolysis, anti-inflammatory, anticoagulants, antioxidants, others
• Molecular biology techniques: gene therapy

1. Capella-Monsonís, H., Kearns, S., Kelly, J. et al. Battling adhesions: from understanding to prevention. BMC biomed eng 1, 5 (2019). https://doi.org/10.1186/s42490-019-0005-0

Flexor Tendon Healing

• created 2021-06-05