Flexor Tendon Injuries: The Results of Primary Repair

1988 ◽  
Vol 13 (3) ◽  
pp. 269-272
Author(s):  
M. SINGER ◽  
S. MALOON
Keyword(s):  
Flexor Tendon ◽  
Primary Repair ◽  
Hand Surgery ◽  
Tendon Injury ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Flexor Tendon Injuries ◽  
No Man's Land ◽  
Flexor Pollicis Longus Tendon ◽  
Flexor Digitorum

This study is a critical analysis of results obtained following primary repair and post-operative controlled mobilisation of flexor tendon injuries which were treated by registrars with up to six months experience in hand surgery. 70 (55%) of 125 patients who underwent repair of a complete flexor digitorum profundus or flexor pollicis longus tendon injury during a 14-month period attended for review and these had a total of 140 injured digits. 93 (67%) were rated Lister’s standards as an “excellent” or “good” result. 39 (28%) occurred in “no man’s land” (Zone 2) and only 19 (49%) in this area were rated “excellent” or “good”. Isolated flexor digitorum superficialis tendon injuries have been excluded from this study, as have partial tendon injuries.

Results of heterodigital flexor digitorum profundus hemi-tendon transfer for 23 flexor tendon injuries in zones 1 or 2

2017 ◽  
Vol 43 (5) ◽  
pp. 487-493 ◽  
Author(s):  
Aude Bommier ◽  
Duncan McGuire ◽  
Patrick Boyer ◽  
Asan Rafee ◽  
Sami Razali ◽  
...  
Keyword(s):  
Tendon Transfer ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Level Of Evidence ◽  
Active Motion ◽  
Flexor Tendon Injuries ◽  
Flexor Digitorum

We report outcomes of reconstruction of zone 1 or 2 flexor tendon injuries using a heterodigital hemi-tendon transfer of the flexor digitorum profundus in 23 fingers of 23 patients. At mean follow-up of 57 months, the mean total active motion of the three finger joints including the metacarpophalangeal joint was 128 degrees preoperatively and 229 degrees at final follow up. According to Strickland criteria, the function was excellent for 14 fingers, good for seven fingers and poor for two fingers. The subgroup analysis showed that the results were better in cases of primary surgery, children, and for the index and little fingers. Complications included stiffness of three fingers, and rupture in one finger that was converted to a two-stage tendon reconstruction. We conclude that this technique restores good function in most patients with zone 1 and 2 flexor tendon injuries, in which primary tendon repair has not been performed or was unsuccessful, and where pulley reconstruction is not required. Level of evidence: IV

scholarly journals A review of current concepts in flexor tendon repair: physiology, biomechanics, surgical technique and rehabilitation.

2015 ◽  
Vol 7 (4) ◽  
Author(s):  
Rohit Singh ◽  
Ben Rymer ◽  
Peter Theobald ◽  
Peter B.M. Thomas
Keyword(s):  
Flexor Tendon ◽  
Primary Repair ◽  
Functional Anatomy ◽  
Tendon Repair ◽  
Hand Surgery ◽  
Suture Repair ◽  
Flexor Tendon Repair ◽  
Flexor Tendon Injuries ◽  
No Man's Land ◽  
American Society

Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man’s land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into world-wide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biomechanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs.

scholarly journals Biomechanical Study of Two Peripheral Suture Methods on Repaired Tendons

Open Medicine ◽  
2014 ◽  
Vol 10 (1) ◽  
Author(s):  
Shixin Wang ◽  
Zhenling Qiu
Keyword(s):  
Flexor Tendon ◽  
Statistical Significance ◽  
Maximum Load ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Surgical Approaches ◽  
Length Group ◽  
Flexor Tendon Injuries ◽  
Stitch Length ◽  
Flexor Digitorum

AbstractFlexor digitorum tendon injuries are challenging conditions to manage to ensure optimal patient outcomes. While several surgical approaches with high success rates have been developed, there remains no gold standard for suture technique for the repair of flexor tendon injuries. In this study, we compared two distinct peripheral suture methods on the strength of repaired tendons. Pig flexor digitorum profundus tendons were used in biomechanical studies and the biomechanical influence on tendon repair of continuous running peripheral suture (CRPS) and continuous locking peripheral suture (CLPS), were compared, using stitch length ranging from 1mm to 5mm. In CRPS, the 1mm stitch length group displayed the highest maximum load and breaking power, which was 1.57 fold higher than the 2mm stitch length group. Pairwise comparison revealed that the 1 and 2mm groups were statistically different from the 3, 4, and 5mm stitch length groups while comparison among the latter groups was not statistically significant. For CLPS, the 1mm group exhibited consistently the highest maximum load strength and breaking power, which was twice the strength displayed by the 2mm group. Pairwise comparisons between groups showed statistical significance. For future repairs of flexor tendon injuries, 1mm stitch length is highly recommended for simple peripheral suture.

Flexor Tendon Injuries and Repairs: A Single Centre Experience

2018 ◽  
Vol 23 (04) ◽  
pp. 487-495 ◽  
Author(s):  
Min Kai Chang ◽  
Shian Chao Tay
Keyword(s):  
Flexor Tendon ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Dominant Hand ◽  
Single Digit ◽  
Economic Implications ◽  
Injury Characteristics ◽  
Patient Demographics ◽  
Flexor Tendon Injuries ◽  
Flexor Digitorum

Background: Although flexor tendon injuries cause significant morbidities and socio-economic implications, there have been limited data on patient demographics, injury characteristics and surgical details. The aim of this study is to describe our experience in flexor tendon injuries and repairs.Methods: We performed a retrospective study of all digital flexor tendon injuries that were repaired from January 2011 to December 2014. The collected data included patient demographics, injury characteristics and surgical details.Results: A total of 214 patients, 308 digits with 446 flexor tendon repairs were identified. We found that males, non-residents, and 20–29 age group were most prone to flexor tendon injuries. Cleaners, labourers and related occupations were the most vulnerable. The mechanism of injury was usually work-related and mostly caused by glass. Most injuries involve both flexor digitorum profundus and flexor digitorum superficialis tendons. Concomitant digital nerve and vessel injuries were common. Most patients suffered zone 2 laceration of a single digit of the non-dominant hand. Most patients underwent procedures that lasted 1 to 2 hours, including multiple flexor tendon repairs, microsurgical repairs and other interventions.Conclusions: This study is the largest study on patient demographics, injury characteristics and surgical details on flexor tendon injuries and repairs. It could be used to plan resources and policies for the management and prevention of flexor tendon injuries.

scholarly journals Two-stage reconstruction for flexor tendon injuries in zone II using a silicone rod and pedicled sublimis tendon graft

2010 ◽  
Vol 43 (01) ◽  
pp. 014-020
Author(s):  
Mohammed Heshmat Abdul-Kader ◽  
Mahmound A. M. Amin
Keyword(s):  
Flexor Tendon ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Two Stage ◽  
Tendon Reconstruction ◽  
Flexor Tendon Injuries ◽  
Silicone Rod ◽  
Zone Ii ◽  
The Mean ◽  
Flexor Digitorum

ABSTRACTWe report the results of staged flexor tendon reconstruction in 12 patients (12 fingers) with neglected or failed primary repair of flexor tendon injuries in zone II. Injuries involved both flexor digitorum profundus (FDP) and flexor digitorum sublimis (FDS), with poor prognosis (Boyes grades II–IV). The procedure included placing a silicone rod and creating a loop between the FDP and FDS in the first stage and reflecting the latter as a pedicled graft through the pseudosheath created around the silicone rod in the second stage. At a mean follow-up of 18 months (range 12–30 months), results were assessed by clinical examination and questionnaire. The mean total active motion of these fingers was 188°. The mean power grip was 80.0% and pinch grip was 76% of the contralateral hand. The rate of excellent and good results was 75% according to the Buck-Gramcko scale. These results were better than the subjective scores given by the patients. Complications included postoperative hematoma in two, infection in one, silicone synovitis in one (after stage I) and three flexion contractures after stage II. This study confirmed the usefulness of two-stage flexor tendon reconstruction using the combined technique as a salvage procedure to restore flexor tendon function with a few complications.

THE BUTTON-OVER-NAIL TECHNIQUE FOR ZONE I FLEXOR TENDON INJURIES

Hand Surgery ◽  
2012 ◽  
Vol 17 (03) ◽  
pp. 365-369 ◽  
Author(s):  
A. S. C. Bidwai ◽  
L. Feldberg
Keyword(s):  
Functional Outcome ◽  
Flexor Tendon ◽  
Surgical Complication ◽  
Tendon Injury ◽  
Outcome Data ◽  
Flexor Digitorum Profundus ◽  
Retrospective Case ◽  
Flexor Tendon Injury ◽  
Flexor Tendon Injuries ◽  
Flexor Digitorum

The "button over the nail" is the most commonly used technique in order to re-insert the flexor digitorum profundus tendon into the distal phalanx in the management of Zone 1 injuries. Recent evidence in the literature has highlighted an associated morbidity with the technique. In this study, 37 patients were identified that had been treated using the "button technique", for which outcome data is collected by hand therapists as part of a prospective flexor tendon injury audit. Retrospective case note review was performed to determine incidence of post-operative surgical complications. There were limited complications with the use of the "button technique" overall. However, functional outcome when compared to other studies are relatively poor with mean range of motion at the distal interphalangeal joint being 37.5 degrees. The authors would recommend any decision to change technique for the management of these injuries should consider functional outcome in the presence of a low surgical complication rate.

Up to five-week delay in primary repair of Zone 2 flexor tendon injuries: outcomes and complications

2021 ◽  
pp. 175319342110244
Author(s):  
Giovanni Munz ◽  
Andrea Poggetti ◽  
Luca Cenci ◽  
Anna Rosa Rizzo ◽  
Marco Biondi ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Primary Repair ◽  
Early Mobilization ◽  
Exercise Programme ◽  
Tendon Injuries ◽  
Level Of Evidence ◽  
Active Motion ◽  
Active Flexion ◽  
Surgical Methods ◽  
Flexor Tendon Injuries

We report the outcomes of delayed primary repair of flexor tendons in Zone 2 in 31 fingers and thumb (28 patients) averaging 15 days (range 4–37) after injury in 2020. The delay was longer than usual due to the COVID-19 pandemic. The tendons were repaired with a 6-strand core suture (M-Tang method) or a double Tsuge suture and a peripheral suture. This was followed by an early, partial-range, active flexion exercise programme. Adhesions in four digits required tenolysis. These patients were not with longest delay. Outcomes of two improved after tenolysis. The other two patients declined further surgery. One finger flexor tendon ruptured in early active motion. This was re-repaired, and final outcome was good. Overall excellent and good results using the Tang criteria were in 27 out of 31 fingers and thumbs (87%). The time elapsed between the injury and surgery is not an important risk factor for a good outcome, rather it depends on proper surgical methods, the surgeon's experience and early mobilization, properly applied. Adhesions may occur, but they can be managed with tenolysis. Level of evidence: IV

Sliding Position of the Flexor Tendons Relative to the Hook of Hamate in CT Scans

2019 ◽  
Vol 24 (01) ◽  
pp. 72-75
Author(s):  
Kenji Goto ◽  
Kiyohito Naito ◽  
Yoichi Sugiyama ◽  
Nana Nagura ◽  
Ayaka Kaneko ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Injury ◽  
Ct Scans ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Ulnar Side ◽  
Flexor Tendon Injury ◽  
Hook Of Hamate ◽  
Flexor Digitorum ◽  
Little Finger

Background: The aim of this study was to assess the height of nonunion formation injuring the ulnar-side finger flexor tendon, the positional relationship between the hook of the hamate and little finger flexor tendon was evaluated on CT scans. Methods: The subjects were 20 healthy patients (40 hands) (14 males and 6 females, mean age: 28 years old). Their hands were imaged in extension and flexion of the fingers on CT. The position of the little finger flexor tendon was determined regarding the height of the hook of the hamate as 100%. Results: The heights of the flexor digitorum profundus tendons were 46 ± 6% in extension and 44 ± 9% in flexion, and those of the flexor digitorum superficialis tendons were 87 ± 8% in extension and 91 ± 9% in flexion. Conclusions: Our study suggested that 40% of the base of the hook of the hamate does not contact with the flexor tendon, suggesting that flexor tendon injury is unlikely to occur in that region.

Patterns of Cellular Activation after Tendon Injury

1996 ◽  
Vol 21 (6) ◽  
pp. 813-820 ◽  
Author(s):  
U. KHAN ◽  
J. C. W. EDWARDS ◽  
D. A. McGROUTHER
Keyword(s):  
Flexor Tendon ◽  
Rabbit Model ◽  
Early Period ◽  
Tendon Injury ◽  
Flexor Digitorum Profundus ◽  
Cellular Activation ◽  
Relative Response ◽  
Tendon Surgery ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

Mechanisms which lead to disabling adhesions following flexor tendon surgery of the hand were investigated in a rabbit model which was used to assess the relative response of the cells of the synovial sheath, epitenon and the endotenon to injury. A transverse laceration, cutting through 50% of the tendon, was made just outside the synovial sheath on the flexor aspect of the flexor digitorum profundus tendon. The synovial sheath was preserved intact. Using monoclonal antibodies for localizing specific inflammatory markers, we were able to follow the response and activity of the synovial sheath, epitenon and endotenon with respect to these markers at various times after surgery. Our findings suggest that the synovial sheath and the epitenon are relatively more reactive in the early period after injury, as judged by a range of inflammatory indices with the notable exception of the expression of the potent neovascularizing agent, basic fibroblast growth factor (bFGF).

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