Abstract
1. Tendon grafts, in order to survive, have to develop a blood supply from their immediate environment. This causes adhesions.
2. Their final range of movement is therefore a sum of the length to which these vascular adhesions will stretch, and the range of movement of the normal tissues to which the tendon has become adherent.
3. Thus it is important that the tendon graft should lie in a bed of yielding material, and that no unyielding structures should be divided in the same wound. When possible, blunt tunnelling between short transverse incisions is the method of choice for placement of grafts.
4. The most crippling adhesions are those that grow from an imperfectly sutured cut end of tendon, leaving it unsatisfied. A new method of tendon anastomosis designed to prevent such adhesions is described.
5. A tendon grafting technique for intrinsic paralysis of the fingers in leprosy, using a radial extensor of the wrist as the motor and the plantaris tendon as the graft, is described.
6. A study of 861 fingers after the operation is presented.
7. The importance of re-education after operation is stressed.
