Adhesions from flexor tendon surgery: An animal study comparing surgical techniques

Intraoperative and postoperative hemorrhage has long been considered a caus e of tendon adhesion and, thus, scarring and poor surgical results. To prev ent such problems bipolar coagulators are commonly used during surgery to h elp achieve hemostasis. Surgical lasers also have been reported to help lim it bleeding and scar formation. Very little is known regarding the relation ship between hemorrhage and/or direct tendon tissue effects and tendon adhe sions with the use of these modalities. We compared 3 different surgical te chniques (meticulous sharp scalpel dissection, scalpel dissection plus bipo lar coagulation, and CO2 laser dissection) and used chicken flexor tendons to biomechanically and histologically assess the amount of adhesion formati on after each procedure. Our findings show that bipolar coagulation and CO2 laser application are both associated with significantly increased adhesio n formation in tendon surgery compared with sharp dissection alone and that the meticulous, conventional sharp dissection technique is the best method to control adhesion formation. These conclusions have relevance to clinica l tendon surgery. (J Hand Surg 2000;25A:252-259. Copyright (C) 2000 by the American Society for Surgery of the Hand.).