The Direct Midlateral Approach with Lateral Enlargement of the Pulley System for Repair of Flexor Tendons in Fingers

1996 ◽  
Vol 21 (4) ◽  
pp. 463-468 ◽  
Author(s):  
A. MESSINA ◽  
J. C. MESSINA
Keyword(s):  
Flexor Tendon ◽  
Skin Flap ◽  
Tendon Repair ◽  
Tendon Sheath ◽  
Flexor Tendon Repair ◽  
Anterior Compartment ◽  
Pulley System ◽  
Neurovascular Pedicle ◽  
Anchoring System ◽  
Palmar Skin

The direct midlateral approach and the lateral enlarging procedure of the pulley system have been utilized in our service since 1972. The incision runs directly behind the neurovascular pedicle, which is left in the palmar skin flap of the anterior compartment of the finger, in order to ensure its blood supply and sensibility. The transverse digital lamina of Landsmeer’s skin anchoring system and Cleland’s ligament are preserved and are used to perform a lateral enlargement of the pulleys after tendon repair. The technique allows wide surgical exposure of the digital fibro-osseous tunnel, enlargement and reconstruction of the pulley system and tendon sheath, flexor tendon repair (using the technique of choice) and reduces postoperative impingement in zone 2.

Predictors of outcome after primary flexor tendon repair in zone 1, 2 and 3

2016 ◽  
Vol 41 (8) ◽  
pp. 793-801 ◽  
Author(s):  
I. Z. Rigo ◽  
M. Røkkum
Keyword(s):  
Flexor Tendon ◽  
Linear Regression Analysis ◽  
Tendon Repair ◽  
Tendon Sheath ◽  
Multiple Linear Regression Analysis ◽  
Level Of Evidence ◽  
Pulley System ◽  
Skeletal Injury ◽  
Active Mobilization

We retrospectively reviewed the outcomes of flexor tendon repairs in zones 1, 2 and 3 in 356 fingers in 291 patients between 2005 and 2010. The mean (standard deviation) active ranges of motion of two interphalangeal joints of the fingers were 98° (40) and 114° (45) at 8 weeks postoperatively and at the last follow-up (mean 7 months, range 3–98), respectively. Using the Strickland criteria, ‘excellent’ or ‘good’ function was obtained in 95 (30%) out of 322 fingers at 8 weeks and 107 (48%) out of 225 fingers at the last follow-up. A total of 48 (13%) fingers required reoperation because of rupture, adhesion, contracture or other complications. The prevalence of rupture was 4%. We carried out multiple linear regression analysis to identify the predictors of the active digital motion. The following variables were found as negative predictors: age; smoking; injury localization between subzones 1C and 2C; injury to the little finger; the extent of soft tissue damage; concomitant skeletal injury; delay to surgery; use of a 2-strand Kessler repair technique; attempted suture or preservation of the tendon sheath–pulley system; and resecting or leaving the concomitant superficial flexor tendon cuts untreated. Analysing the 8 weeks results of tendon repairs in zones 1 and 2, early active mobilization was found to be superior to Kleinert’s regime. Level of evidence: III

Efficacy of Adcon-T/N After Primary Flexor Tendon Repair in Zone II: A Controlled Clinical Trial

2003 ◽  
Vol 28 (2) ◽  
pp. 113-115 ◽  
Author(s):  
A. GOLASH ◽  
A. KAY ◽  
J. G. WARNER ◽  
F. PECK ◽  
J. S. WATSON ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Sheath ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Flexor Tendon Repair ◽  
Double Blind ◽  
Active Motion ◽  
Zone Ii

A prospective double-blind, randomized, controlled clinical trial was conducted to assess the use of ADCON-T/N after flexor tendon repair in Zone II. Forty-five patients with 82 flexor tendon repairs in 50 digits completed the study. ADCON-T/N was injected into the tendon sheath after tenorrhaphy in the experimental group while the control group was not treated with ADCON-T/N. ADCON-T/N had no statistically significant effect on total active motion at 3, 6 and 12 months but the time taken to achieve the final range of motion was significantly shorter in treated patients. ADCON-treated patients had a higher rupture rate but this was not significant.

scholarly journals Flexor tendon repair: a comparative study between a knotless barbed suture repair and a traditional four-strand monofilament suture repair

2013 ◽  
Vol 39 (1) ◽  
pp. 40-45 ◽  
Author(s):  
C. W. Joyce ◽  
K. E. Whately ◽  
J. C. Chan ◽  
M. Murphy ◽  
F. J. O’Brien ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Biomechanical Testing ◽  
Tendon Repair ◽  
Barbed Suture ◽  
Suture Repair ◽  
Flexor Tendon Repair ◽  
Cross Sectional ◽  
Pulley System ◽  
Suture Group

We compared the tensile strength of a novel knotless barbed suture method with a traditional four-strand Adelaide technique for flexor tendon repairs. Forty fresh porcine flexor tendons were transected and randomly assigned to one of the repair groups before repair. Biomechanical testing demonstrated that the tensile strengths between both tendon groups were very similar. However, less force was required to create a 2 mm gap in the four-strand repair method compared with the knotless barbed technique. There was a significant reduction in the cross-sectional area in the barbed suture group after repair compared with the Adelaide group. This would create better gliding within the pulley system in vivo and could decrease gapping and tendon rupture.

Providing Quantitative Feedback When Teaching Tendon Repair: A New Tool

2005 ◽  
Vol 30 (6) ◽  
pp. 626-632 ◽  
Author(s):  
J. C. BERSCHBACK ◽  
P. C. AMADIO ◽  
C. ZHAO ◽  
M. E. ZOBITZ ◽  
K. N. AN
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Sheath ◽  
Flexor Tendon Repair ◽  
Hand Surgeon ◽  
Repair Technique ◽  
Academic Medical ◽  
Biomechanical Parameters ◽  
Set Up

Flexor tendon repair remains one of the more difficult technical tasks facing the hand surgeon. A good repair must be both strong and able to glide smoothly through the tendon sheath. The purpose of this study is to present a model that allows surgeons to improve their technique of flexor tendon repair by receiving feedback on these important biomechanical parameters. The set-up requires testing equipment found in most biomechanical laboratories and should be available in many academic medical centres. Preliminary data suggest that receiving feedback about the strength and smoothness of a flexor tendon repair may be a very useful tool in helping surgeons improve the overall quality of their tendon repair technique.

LENGTHENING THE LOCKING LOOP REPAIR FOR ZONE 2 FLEXOR TENDON LACERATION AND PARTIAL LATERAL RELEASE OF THE TENDON SHEATH

Hand Surgery ◽  
2009 ◽  
Vol 14 (02n03) ◽  
pp. 125-129 ◽  
Author(s):  
Hithoshi Hatanaka ◽  
Tetsuo Kojima ◽  
Tomoyuki Miyagi ◽  
Tomoyuki Mizoguchi ◽  
Yoshifumi Ueshin
Keyword(s):  
Clinical Outcomes ◽  
Flexor Tendon ◽  
Full Range ◽  
Tendon Repair ◽  
Tendon Sheath ◽  
Lateral Release ◽  
Flexor Tendon Repair ◽  
Loop Technique ◽  
Tendon Laceration

The authors present the clinical outcomes of nine zone 2 flexor tendon repairs using a locking loop technique (i.e. the Modified Pennington technique). The locking loops were located approximately 10 mm away from the lacerated tendon ends to "lengthen" the locking loop repair, as experimentally and clinically recommended. The partial lateral release of the tendon sheath, including the A2 and/or A4 pulley, was performed not only to locate the sutures but also to allow a full range of motion of the repair without catching on the tendon sheath, as clinically recommended. All the patients were followed up for six months or more except for one. All digits were evaluated as excellent or good at the final follow-up by the original Strickland criteria. No rupture occurred and no bowstring of the flexor tendon was observed. The clinical outcomes of the current study indicate that "lengthening" the locking loop repair is effective for zone 2 flexor tendon repair and that the partial lateral release of the tendon sheath, including the A2 and/or A4 pulley, does not result in the bowstring of the flexor tendon.

Use of porcine trotters as models for flexor tendon repair—the pulley system

2013 ◽  
Vol 36 (7) ◽  
pp. 449-452 ◽  
Author(s):  
Mobinulla Syed ◽  
Quintin Frew ◽  
Manu Sood
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Pulley System

A New Approach to Flexor Tendon Repair

1994 ◽  
Vol 19 (4) ◽  
pp. 513-516 ◽  
Author(s):  
P. P. CALLAN ◽  
W. A. MORRISON
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Sheath ◽  
Simple Approach ◽  
Flexor Tendon Repair ◽  
New Approach ◽  
Flexor Tendon Sheath

This paper describes a new and simple approach to the flexor tendon via strategically placed transverse incisions in the flexor tendon sheath.

Flexor Tendon Repair in “No Man's Land” An Experimental Study

HAND ◽  
1977 ◽  
Vol os-9 (2) ◽  
pp. 143-146
Author(s):  
A. R. Moscona ◽  
R. Sekel ◽  
E. R. Owen
Keyword(s):  
Experimental Study ◽  
Success Rate ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Sheath ◽  
Flexor Tendon Repair ◽  
Flexor Tendon Sheath ◽  
No Man's Land

Twenty-five fingers of seven monkeys were used for an experimental study of a new concept of flexor tendon repair in “No Man's Land”. Microsurgical aids were used to shift distally a sleeve of healthy flexor tendon sheath to cover the site of the repaired flexor tendon. There was a low success rate due to technical difficulties in the immobilisation of the monkey fingers. Where the finger was successfully immobilised the results were encouraging.

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