The use of paratenon, polyethylene film, or silastic sheeting to prevent restricting adhesions to tendons in the hand.

We treated 132 patients by insertion of paratenon, polyethylene, or Silastic between a digital tendon and a bone, ligament, or fixed fascial structure to prevent adhesions. From 1950 to 1974, autogenous paratenon was used in thirty patients; from 1956 to 1965, polyethylene film was used in sixty-three patients; and from 1965 to 1974, Silastic sheeting was used in thirty-nine patients. By comparing the preoperative and postoperative measurements of joint motion and the changes in the distance separating the pulp of a finger from the palm during flexion, these patients were calssified as improved, unchanged, or worse. In some areas the material used appeared to make little difference, but in other areas one or the other was superior. Silastic sheeting (non-reinforced) proved to be the best material for most conditions, but it should not be employed when the skin is of poor quality or beneath a pedicle flap, and it should not be used adjacent to a tendon graft in an area that has recovered from an infection. Under those circumstances, paratenon is the preferred material.