Fibrosis is the greatest enemy of function in the hand. It causes skin to be adherent to bone, and to be prone to easy ulceration with trauma. It makes the injured nerve either completely nonconducting or the cause of severe pain. It grows between fractured ends of bones, to result in nonunion. But its greatest and most easily recognized insult to the structures of the hand is manifested after injury to tendons. If extensive scarring occurs, or even if minimal scarring grows from the healed tendon to inelastic structures, the tendon will not glide.
Some fibrosis from the laceration is inevitable. Our aim is to minimize this reaction, and not to add to it.
Natural Causes of Fibrosis
The natural causes of fibrosis are (1) injuries to tissue: lacerated, crushed, and avulsed; (2) exposure of raw tissues to any environment but skin; (3) hematoma formation; (4) lymph pocketing; (5) edema,
BURNHAM PJ. Repair of Tendon Injuries in the Hand. AMA Arch Surg. 1959;78(2):316-321. doi:10.1001/archsurg.1959.04320020138021