Functional outcomes of a modified Duran postoperative rehabilitation protocol after primary repairs of pediatric hand flexor tendon injuries

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
James S. Lin ◽  
Julie Balch Samora
Keyword(s):  
Functional Outcomes ◽  
Flexor Tendon ◽  
Tendon Injuries ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Protocol ◽  
Flexor Tendon Injuries

scholarly journals An analysis of the effect of the technique of the repair and postoperative rehabilitation protocol on the treatment outcomes of flexor tendon injuries: a review

2020 ◽  
Vol 66 (3) ◽  
Author(s):  
Andrzej Żyluk ◽  
Bernard Piotuch
Keyword(s):  
Treatment Outcomes ◽  
Flexor Tendon ◽  
Scientific Evidence ◽  
Tendon Repair ◽  
Conclusive Evidence ◽  
Tendon Injuries ◽  
Flexor Tendon Repair ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Protocol ◽  
Flexor Tendon Injuries

This study covers updated information on the methods of the repair of flexor tendon injuries, postoperative rehabilitation protocols and their effect on treatment outcomes. Contemporary techniques of flexor tendon repair are based on combinations of various types of core sutures and circumferential epitenon sutures. Literature shows a tendency of replacing earlier 2-strand core tendon sutures with novel multistrand core sutures, however the results of meta-analyses do not confirm any definitive superiority over traditional techniques. Likewise, literature does not provide conclusive evidence that early active postoperative mobilization results in better outcomes than active-passive and controlled passive mobilization techniques. The choice of the method of flexor tendon repair and postoperative rehabilitation protocol depends only in part on scientific evidence, but more on individual or institutional preference of the surgeon.

Outcomes After Flexor Tendon Injuries in the Pediatric Population: A 10-Year Retrospective Review

Hand ◽  
2020 ◽  
pp. 155894472092665
Author(s):  
Minh N. Q. Huynh ◽  
Ammara Ghumman ◽  
Amisha Agarwal ◽  
Claudia Malic
Keyword(s):  
Flexor Tendon ◽  
Pediatric Population ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Complication Rates ◽  
Active Motion ◽  
Rehabilitation Protocol ◽  
Injury Characteristics ◽  
Patient Demographics ◽  
Flexor Tendon Injuries

Background: Pediatric outcomes after flexor tendon repairs are variable, and evidence in the literature remains scarce. Methods: Repair of pediatric flexor tendon injuries was reviewed over a 10-year period (2005-2015). Data collection consisted of patient demographics, injury characteristics, anesthetic choice, repair technique, rehabilitation protocol, American Society for Surgery of the Hand Total Active Motion (TAM) scores, and complications. Results: There were 109 patients included in our study, with a total of 162 digits injured and 235 flexor tendon injuries. The mean age was 12 ± 4.6 years. The small finger (48 of 162; 30%) and the flexor digitorum profundus tendon (126 of 235) were the most commonly injured. The mechanism of injury was mainly from a knife (46 of 109; 42.2%) in zone II (82 of 159; 52%). Injuries were mostly repaired under general anesthetic (61 of 104; 56%). The Kessler technique was the predominant repair mechanism (111 of 225 repairs; 49%). Most patients (103 of 109; 95%) had excellent or good TAM scores with 5 postoperative ruptures reported. The most common complication was stiffness (17 of 121 complications; 14%), with most patients having no complications ( 74 of 109 patients; 68%). Patients were commonly immobilized (mean 8.4 ± 10.3 weeks) with a splint (93 of 109; 85%). There were 85 patients who followed a postoperative rehabilitation protocol for 12 ± 18 weeks. Patient demographics, time of repair, injury characteristics, anesthetic choice, and rehabilitation protocol were not significantly correlated with TAM scores or complication rates. Conclusions: Pediatric tendon injuries have good outcomes with no predictive factors identified. Surgical repairs performed under local anesthetic have similar outcomes without increased rates of complications, but remain underused in the pediatric population.

Use of tissue engineering in the reconstruction of flexor tendon injuries

2015 ◽  
Vol 156 (6) ◽  
pp. 216-220 ◽  
Author(s):  
Vilmos Bíró
Keyword(s):  
Tissue Engineering ◽  
Flexor Tendon ◽  
Healing Process ◽  
Tendon Injuries ◽  
Literary Analysis ◽  
Tendon Tissue ◽  
Postoperative Rehabilitation ◽  
Normal Tendon ◽  
Flexor Tendon Injuries ◽  
Definition Of

In his literary analysis, the author describes a novel method applied in the reconstruction of flexor tendon injuries of the hand. This procedure is named tissue engineering, and it is examined mainly under experimental circumstances. After definition of the method and descriptions of literary preliminaries the author discusses the healing process of the normal tendon tissue, then development of the scaffold, an important step of tissue engineering is described. After these topics the introduction of the pluripotent mesenchymal stem cells into the scaffold, and proliferation of these cells and development of the sliding systems are presented. The mechanical resisting ability of the formed tendon tissue is also discussed. Finally, the author concludes that as long as results of experimental research cannot be successfully applied into clinical practice, well-tried tendon reconstruction operations and high quality postoperative rehabilitation are needed. Orv. Hetil., 2015, 156(6), 216–220.

Evaluation of flexor tendon repair (zone II) with Wide Awake Anesthesia

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Adel Zaghloul Fayed ◽  
Naglaa Mohamed Abdel Aziz ◽  
Ebrahim Mohamed Amin Abdel Gawad ◽  
Ibrahim Hussien Kamel ◽  
Ahmed Elshahat
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Rehabilitation Protocol ◽  
Flexor Tendon Injuries ◽  
Zone Ii ◽  
Active Rehabilitation ◽  
Wide Awake

Abstract Background Recent advances in hand surgery has been the movement away from tourniquet surgery, which often requires sedation or GA and the patient will be awake and cooperative. Wide awake approach depends on the safety of adrenaline which is now well established. This review will evaluate the role of the wide awake approach in reducing rupture and tenolysis rate after flexor tendon repair zone 2. Objective To evaluate the functional outcome of flexor tendon repair zone II (most challengeable) under wide awake anesthesia. Patients and Methods After approval of local ethical committee of faculty of medicine Ain Shams University, this Prospective study has been conducted targeting patients with acute zone II flexor tendon injuries admitted at El Sahel Teaching Hospital within the period from September 2019 till January 2020, and their follow up for minimum three months at outpatient clinic. A Written informed consent explaining the whole procedure under study in this research has been obtained from all patients and absolute confidentiality as regard the patients’ names and addresses was given special care and attention. Final outcome evaluated by Original Strickland evaluation system. Results Using the wide awake technique provides an optimal opportunity to test repair strength through Intra-operative Total Active Movement (ITAM) making the surgeon much more comfortable to initiate early active motion. Besides, rising trend toward using early active rehabilitation protocol in case of strong repair using four or more strands repairs is recently supported in literature. This study adopted early active rehabilitation protocol with slight differences among them Conclusion This preliminary study assessing the outcomes of primary tendon repair in flexor tendon injuries in zone II using the wide-awake technique demonstrates encouraging results, being satisfactory for both surgeons and patients that makes this new approach a competitive to the other approaches of flexor tendon repair implemented under conventional methods of anesthesia.

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

Treatment of flexor tendon injuries: Surgeons' perspective

1999 ◽  
Vol 12 (2) ◽  
pp. 141-148 ◽  
Author(s):  
John S. Taras ◽  
Marc J. Lamb
Keyword(s):  
Flexor Tendon ◽  
Tendon Injuries ◽  
Flexor Tendon Injuries
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