الفهرس 
Embryology and anatomy of the flexor tendons.Only 14 pages are availabe for public view
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Abstract
Background: This study was done to assess the technique of using an autogenous vein graft over the flexor tendon repair to prevent post-operative peritendinious adhesions which restrict the motion.
Methods:15 patients (13 male patients and two female patients) were seen between January 2011 and January 2016 in Al Mataria Teaching Hospital. The age of the patients participating in the study ranged from 18.5 and 25.5 years. Those 15 patients were randomly selected among the cases of acute flexor tendon injury coming to the hospital in whom both flexors were lacerated in zone II.
All repairs were done by the modified Kessler technique. Following tendon repair part of marked sizable forearm vein was harvested. The vein graft segment is sutured to the tendon sheath window in a way so that the smooth intima is facing the repair site. This vein graft segment is considered as a replacement of the tendon sheath where the tendon is gliding.
Post-operative program of controlled active mobilization is applied. The fingers were initially mobilized with the wrist splint in place by the aid of rubber bands. The mobilization program comprised gentle active extension of the interphalangeal joints followed by passive flexion using the rubber bands. rubber bands discarded after three weeks. By the end of the forth week gentle active mobilization started. Angels of the splint were gradually extended every two weeks, the Splint was discarded by the end of the 6th week and gentle resistive exercises started. The range of flexion as well as the number of movements and sessions were gradually increased according to the condition and progress of the patient.
All patients were assessed using the second buck-gramcko scale of assessment. This was done at 8 weeks and finally after a follow-up period of 6 months.
Results: The final assessment revealed excellent results achieved in 4 cases, while very good results were achieved in 5 digits, good results were achieved in 5 digits, fair results were achieved in 1 digit, and no poor results.
So the use of autologous vein graft as a substitute of tendon sheath has many advantages like; it is not expensive, being autologous so not carrying the risk of infection, also it will not affect the tendon healing like other materials. comparing it to the conventional tendon repair technique, it was associated with less adhesion formation and less joint contracture.
Conclusion: After studying this technique in a multi-center study, it can be added as a routine step in cases of primary repairs and secondary tendon reconstruction in which we are expecting adhesion formation.