Modulation of the formation of adhesions during the healing of injured tendons.
The formation of restrictive adhesions around the musculotendinous unit after injury is one of the most vexing processes faced by the surgeon. In flexor tendons it has been shown that the synovial tissue is the source of aggressive fibroblasts which contribute to this process. Using a rabbit model, we have examined the effects of treating the synovial sheath with the antimetabolite 5-fluorouracil (5-FU) for five minutes. Inflammatory, proliferative and molecular markers were compared in the response of the treated and control tendons to injury. Compared with a control group we found that the proliferative and inflammatory responses were significantly reduced (p < 0.001) in the treated tendons. Not only was there a reduction in the cellular and cytokine response, but there also was a significant (p < 0.001) reduction in the level of activity of the known pro-scarring agent, transforming growth factor beta 1 (TGF-beta1). These pilot studies indicate that the formation of restrictive adhesions may be modulated using a simple single-touch technique in the hope of producing a better return of function.
Khan
U
U
Department of Plastic and Reconstructive Surgery, University College, Grafton Way, London, UK.
Kakar
S
S
Akali
A
A
Bentley
G
G
McGrouther
D A
DA
D000818:Animals; D002452:Cell Count; D004195:Disease Models, Animal; D005347:Fibroblasts / Q000187:drug effects / Q000502:physiology; D005472:Fluorouracil / Q000627:therapeutic use; D006614:Hindlimb; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008264:Macrophages / Q000187:drug effects / Q000473:pathology; D008297:Male; D008854:Microscopy, Electron; D009135:Muscular Diseases / Q000517:prevention & control*; D010865:Pilot Projects; D018809:Proliferating Cell Nuclear Antigen / Q000032:analysis; D011817:Rabbits; D011897:Random Allocation; D018709:Statistics, Nonparametric; D013583:Synovial Membrane / Q000187:drug effects / Q000502:physiology; D013708:Tendon Injuries / Q000150:complications* / Q000503:physiopathology; D013710:Tendons / Q000187:drug effects; D000267:Tissue Adhesions / Q000517:prevention & control; D016212:Transforming Growth Factor beta / Q000187:drug effects; D053773:Transforming Growth Factor beta1; D019010:Vascular Cell Adhesion Molecule-1 / Q000032:analysis; D014945:Wound Healing
D007166:Immunosuppressive Agents; D018809:Proliferating Cell Nuclear Antigen; D016212:Transforming Growth Factor beta; D053773:Transforming Growth Factor beta1; D019010:Vascular Cell Adhesion Molecule-1; D005472:Fluorouracil