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The interior of the flexor tendon sheath of the finger. The functional significance of its structure

1988; British Editorial Society of Bone & Joint Surgery; Volume: 70-B; Issue: 4 Linguagem: Inglês

10.1302/0301-620x.70b4.3403601

2044-5377

AA Amis, MM Jones,

Reconstructive Surgery and Microvascular Techniques

We examined the structure of the digital flexor sheath by dissection and histology. The inner aspect of the sheath was found not to be a continuous smooth surface, as depicted in anatomical and surgical texts. The thin parts of the sheath often overlapped the pulleys before attaching to their superficial aspects, so that the pulleys possessed free edges within the sheath. The frequency of occurrence and sizes of these overlaps were studied in 48 cadaveric fingers; the largest and most frequent overlap was at the distal end of the A2 pulley. Functional studies showed an intricate mechanism of pulley approximation and sheath bulging during flexion. Sutured or partly cut tendons triggered on the free edges; this could be a major contributor to the failures of tendon repairs in "no man's land".