Morphologic observations of neosheath development of undifferentiated connective tissue development around artificial tendons

The management of severe flexor tendon injuries of the hand has been dramatically improved by tendon sheath reconstruction with an artificial tendon, followed by conventional tendon grafting. The purpose of this study was to investigate the nature of neosheath formation. In 25 chickens, the flexor tendons and sheaths in a toe were excised and replaced with a United States Army artificial tendon. An artificial tendon was also placed in the back, and four weeks later, tendons and surrounding tissue as well as normal tendon sheaths were excised and submitted for light, transmission electron microscopy and scanning electron microscopy. In all instances, neosheaths formed around the silastic coated artificial tendon. The neosheaths formed in the foot and back were similar to normal sheath, having the same cellular and fibrous composition. Reconstruction of the normal anatomy with an artificial tendon explains why this surgical technique gives superior results to other less physiologic procedures in patients with severe hand injuries.