PRIMARY REPAIR OF ZONE I FLEXOR TENDON INJURIES

Hand Surgery ◽  
2013 ◽  
Vol 18 (01) ◽  
pp. 79-83 ◽  
Author(s):  
A. S. C Bidwai ◽  
L. Feldberg
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Active Movement ◽  
Suture Repair ◽  
Excellent Outcome ◽  
Pinch Grip ◽  
Post Surgery ◽  
Flexor Tendon Injuries

Eighty-two patients who were treated by suture repair for Zone I flexor tendon injuries over a ten-year period were identified, to determine the incidence of post-operative surgical complications and subsequent re-operations. Eighty-five percent of patients completed 12 weeks follow-up post-surgery. Of these patients almost all had good to excellent outcome in terms of total active movement (TAM). However when assessing the range of motion at the distal interphalangeal joint (DIPJ), only 23% could be classified as having good or excellent results at final follow-up. A total of six patients (7.32%) required surgery for tendon repair complications. This study illustrates that DIPJ ROM is more indicative of functional recovery after tendon repair in flexor Zone I. Given the DIPJ is important in providing a fine pinch and a span pinch grip movements, patients should be counselled for inability to perform these functions post-tendon repair.

Flexor Tendon Repair in Zone 2 Followed by Controlled Active Mobilisation

1989 ◽  
Vol 14 (4) ◽  
pp. 392-395
Author(s):  
K. W. CULLEN ◽  
PAMELA TOLHURST ◽  
D. LANG ◽  
R. E. PAGE
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Adult Patients ◽  
Flexor Tendon Repair ◽  
Flexor Tendon Injuries

Over a two-year-period, 34 adult patients who had suffered zone two flexor tendon injuries to 38 fingers (70 tendons) were managed post-operatively by a regime of early active mobilisation. The results of this technique, assessed by the Strickland criteria after a mean follow-up period of 10.2 months, compared favourably with other more cumbersome methods.

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 An Overview of the Management of Flexor Tendon Injuries

2012 ◽  
Vol 6 (1) ◽  
pp. 28-35 ◽  
Author(s):  
M Griffin ◽  
S Hindocha ◽  
D Jordan ◽  
M Saleh ◽  
W Khan
Keyword(s):  
Flexor Tendon ◽  
Current Knowledge ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Tendon Injury ◽  
Tendon Injuries ◽  
Flexor Tendon Repair ◽  
Flexor Tendon Injury ◽  
Post Surgery ◽  
Flexor Tendon Injuries

Flexor tendon injuries still remain a challenging condition to manage to ensure optimal outcome for the patient. Since the first flexor tendon repair was described by Kirchmayr in 1917, several approaches to flexor tendon injury have enabled successful repairs rates of 70-90%. Primary surgical repair results in better functional outcome compared to secondary repair or tendon graft surgery. Flexor tendon injury repair has been extensively researched and the literature demonstrates successful repair requires minimal gapping at the repair site or interference with tendon vascularity, secure suture knots, smooth junction of tendon end and having sufficient strength for healing. However, the exact surgical approach to achieve success being currently used among surgeons is still controversial. Therefore, this review aims to discuss the results of studies demonstrating the current knowledge regarding the optimal approach for flexor tendon repair. Post-operative rehabilitation for flexor tendon surgery is another area, which has caused extensive debate in hand surgery. The trend to more active mobilisation protocols seems to be favoured but further study in this area is needed to find the protocol, which achieves function and gliding but avoids rupture of the tendons. Lastly despite success following surgery complications commonly still occur post surgery, including adhesion formation, tendon rupture and stiffness of the joints. Therefore, this review aims to discuss the appropriate management of these difficulties post surgery. New techniques in management of flexor tendon will also be discussed including external laser devices, addition of growth factors and cytokines.

Flexor tendon repair in zone III

2010 ◽  
Vol 36 (1) ◽  
pp. 48-52 ◽  
Author(s):  
Mohammad M. Al-Qattan
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Pain Syndrome ◽  
Tendon Injuries ◽  
Grading System ◽  
Flexor Tendon Repair ◽  
Excellent Outcome ◽  
Flexor Tendons ◽  
Active Range Of Motion ◽  
Flexor Tendon Injuries

There is a paucity of the literature on the outcome of zone III flexor tendon injuries. In this paper, we report on the results of zone III flexor tendon repair in 35 consecutive adult patients with clean cut lacerations of both flexor tendons in 42 fingers. There were 25 men and 10 women with an average age of 32 years. Repair of both flexor tendons was performed using ‘figure of eight’ core sutures and a continuous epitendinous suture. Postoperatively, an immediate active range of motion protocol was applied to ensure full active extension of the interphalangeal joints. The results were assessed using the Strickland–Glogovac grading system. There were no ruptures. One patient with two injured fingers developed complex regional pain syndrome and the final outcome was fair in both fingers. In the remaining 34 patients (40 fingers), 33 patients (38 fingers) had an excellent outcome and the remaining patient (two fingers) had a good outcome.

scholarly journals Wide awake surgery for flexor tendon primary repair: A literature review

2020 ◽  
Author(s):  
Camillo Fulchignoni ◽  
Mario Alessandri Bonetti ◽  
Giuseppe Rovere ◽  
Antonio Ziranu ◽  
Giulio Maccauro ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Flexor Tendon ◽  
Primary Repair ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Awake Surgery ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Flexor Tendon Injuries ◽  
Wide Awake

Flexor tendon injuries are extremely challenging conditions to manage for hand surgeons. Over the last few years enormous progress has been made for the treatment of these lesions with new surgical approaches being performed. One of these is the wideawake local anesthesia no tourniquet (WALANT) technique, also known as Wide Awake Technique that allows tendon repair under local anesthesia, enabling the tendon to move actively during surgery. Dynamic movement of the tendon during surgery is crucial for the orthopedic surgeon in order to understand if the tendon has been correctly repaired before leaving the operatory table. An electronic literature research was carried out on Pubmed, Google Scholars and Cochrane Library using ((Flexor tendon injury) OR (flexor tendon) OR (injury muscle tendon) OR (flexor pollicis longus tendon) AND ((wide awake repair) OR (wide awake) OR (wide awake hand surgery))as search terms. Authors believe that WALANT is an enormous add-on in the management of patients with flexor tendon injuries mainly because it allows direct visualization of the repair during flexion and extension movement of the fingers and also because it avoids general anesthesia or brachial plexus being more cost effective. The aim of these review was therefore to sum up the evidences available so far on the wade awake technique as an emerging treatment for patients with flexor tendon injuries.

Zone 2 flexor tendon injuries: Our experience with early active movement protocol for rehabilitation of tendons

2019 ◽  
Vol 26 (10) ◽  
pp. 2110
Author(s):  
Mohammad Khan ◽  
Mohammed Khurram ◽  
Arshad Khan ◽  
Nazia Habiba ◽  
Madhav Chowdhry
Keyword(s):  
Flexor Tendon ◽  
Tendon Injuries ◽  
Active Movement ◽  
Flexor Tendon Injuries

Flexor tendon injuries in the child

2013 ◽  
Vol 39 (1) ◽  
pp. 46-53 ◽  
Author(s):  
M. M. Al-Qattan
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Skin Closure ◽  
Two Stage ◽  
Flexor Tendon Repair ◽  
Technical Aspects ◽  
Tendon Reconstruction ◽  
Flexor Tendons ◽  
Flexor Tendon Injuries

This review aims to highlight the differences in the management of flexor tendon injuries between children and adults. These include differences in epidemiology, anatomy, classification, diagnosis, incisions and skin closure, the size of the flexor tendons, technical aspects of zones I and II repairs, core suture purchase length, rehabilitation, results, and complications of primary flexor tendon repair. Finally, one- versus two-stage flexor tendon reconstruction in children is reviewed.

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.

Flexor Tendon Injuries in Children

1994 ◽  
Vol 19 (6) ◽  
pp. 696-698 ◽  
Author(s):  
A. O. GROBBELAAR ◽  
D. A. HUDSON
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Flexor Tendon Repair ◽  
Flexor Tendons ◽  
Ulnar Nerve Palsy ◽  
Flexor Tendon Injuries ◽  
Rapid Healing ◽  
Tendon Ruptures ◽  
Better Than

Flexor tendon injuries in adults differ from those in children. 38 children (22 male and 16 female) with a mean age of 6.7 years were treated for flexor tendon injuries by primary suture and controlled mobilization between 1985 and 1992. 53 flexor tendons were injured (average 1.5 digits per patient) and the injury most commonly affected the little finger (23 patients). 60% of injuries occurred in zone 2. Using Lister’s criteria, 82% achieved excellent or good results. Repair of both FDS and FDP was better than repair of FDP alone, even in zone 2. There were three tendon ruptures (all classified as poor results) and one other poor result occurred in a zone 2 injury with an associated ulnar nerve palsy. The outcome after flexor tendon repair in children is better than in adults in our hands because rapid healing of tendons occurs in children. No child has yet required tenolysis because in children adhesions are more pliable. Both flexor tendons should be repaired irrespective of the zone of injury. A functional hand can be expected after flexor tendon repair in children.

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