Prevention of adhesions in surgery of the flexor tendons of the hand: what is the evidence?
BACKGROUND
Despite advances in knowledge and refinements of technique, the management of flexor tendon injuries within the digital sheath continues to present a formidable challenge. This in turn has led to a massive expansion in search of modified surgical therapies and various adjuvant therapies, which could prevent adhesion formation without compromising digital function.


METHODS
A search of PubMed, Medline, CINAHL and Embase databases was performed using the keywords 'tendon adhesion prevention', 'tendon healing', 'adhesion prevention in tendons' and 'adjuvants for adhesion prevention'. Studies detailing the use of surgical, pharmacological and non-pharmacological agents for adhesion prevention in digital flexor tendons were identified, and their bibliographies were thoroughly reviewed to identify further related articles. This search identified 41 studies, which investigated the use of various pharmacological agents in adhesion prevention in digital tendons.


RESULTS
There is a need to develop and utilize an optimal method for the prevention of adhesions in the flexor tendons of the hand, due to post-surgical complications.


RESULTS
Even though there have been significant advances in the prevention of adhesions in flexor tendons, it remains to be proved which, if any, of the current methods are the most beneficial.


CONCLUSIONS
The only thing that appears clinically justified in adhesion prevention is the need for early post-operative mobilization of digits after tendon injury or repair but the best method of mobilization remains controversial.


CONCLUSIONS
Suggested changes in surgical techniques and various proposed pharmacological and non-pharmacological modalities need to withstand the test of adequately powered human trials, before their justification for potential benefit in clinical practice is accepted.
Khanna
Anil
A
Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London E1 4DG, UK.
Friel
Mike
M
Gougoulias
Nikolaos
N
Longo
Umile Giuseppe
UG
Maffulli
Nicola
N
D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001696:Biomechanical Phenomena; D017024:Chemotherapy, Adjuvant; D019317:Evidence-Based Medicine; D006230:Hand Injuries / Q000601:surgery* / Q000628:therapy; D006801:Humans; D013536:Suture Techniques; D013708:Tendon Injuries / Q000601:surgery*; D013710:Tendons / Q000601:surgery*; D000267:Tissue Adhesions / Q000517:prevention & control; D016896:Treatment Outcome; D014945:Wound Healing
D000894:Anti-Inflammatory Agents, Non-Steroidal