The immediate restoration of parts to the normal position after tenotomy / by Reginald H. Sayre.
- Sayre, Reginald H.
- Date:
- 1886
Licence: Public Domain Mark
Credit: The immediate restoration of parts to the normal position after tenotomy / by Reginald H. Sayre. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![“adhesions will, in many cases, prevent sufficient separation of the divided extremities of the tendon being obtained.” Paget did not look on the tendons in his rabbits with precisely the same eyes as Mr. Adams, though many of their conclusions are similar. He especially differs in attributing little or no import- ance to the connective tissue sheath, for reasons which Mr. Adams believes to be fallacious, as I have shown. According to Paget,* “ in rabbits forty-eight hours usually elapse before there are distinct signs of the production of the proper reparative material in the fibro-cellular tissue that lies between and close round the separated ends of the tendon, as well as in the tendonous fasciculi of those ends. * * * To f-]ie naked eye it appears, after three days, as a soft, moist, and grayish substance with a slight reddish tinge extending from one end of the tendon to the other, having no well marked boundary and merging gradually into the surround- ing parts. In its gradual progress the reparative material becomes commensurately firmer, tougher and grayer, the ruddiness succes- sively disappearing from the circumference to the axis ; it becomes also more defined from the surrounding parts, and after four or five days forms a distinct cord-like vascular bond of connection between the ends of the tendon, extending through all the space from which they have retracted, and for a short distance ensheath- ing them both. * * * In every experiment one finds cause for admiration at the manner in which a single well-designed and cord-like bond of union is thus gradually formed where at first there had been a uniform and seemingly purposeless infiltra- tion of the whole space left by the retraction of the tendon.” (The italics are mine.) I have shown that Adams’ experiments lead to the logical con- clusion that there is no danger in immediate separation of the ends of the divided tendon. Practically, in the human subject, it would be almost impossible in many instances to keep them closely approximated, and if we do not agree with Mr. Adams in accept- ing the importance of the sheath in the production of the new bond of union, but prefer the theory of Sir James Paget, there is still no more reason for advocating the retention of parts in the distorted position for a longer or shorter period before commenc- ing replacement, and the statement made in this same connection, * Lectures on Surgical Pathology, London, 1870, p. 200.](https://iiif.wellcomecollection.org/image/b22476623_0017.jp2/full/800%2C/0/default.jpg)
