Vascularized dorsal digital fascial flap improves flexor tendon repairs

2013 ◽  
Vol 39 (7) ◽  
pp. 714-718 ◽  
Author(s):  
L.-Q. Sun ◽  
G. Zhao ◽  
S.-H. Gao ◽  
C. Chen
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Distal Interphalangeal Joint ◽  
Flexor Tendon Repair ◽  
Fascial Flap ◽  
Group A ◽  
Distal Interphalangeal ◽  
Zone Ii ◽  
Group B ◽  
Flexor Digitorum

We report a new method of flexor tendon repair in zone II using a standard modified Kessler technique combined with a vascularized dorsal fascial flap from the finger pedicled on a dorsal cutaneous branch of the proper digital artery, which is placed as a mechanical barrier between the flexor digitorum superficialis and profundus tendons. The functional outcomes of 14 patients (Group A) with flexor tendon repairs in zone II by this new technique were compared with those of 32 patients (Group B) with flexor tendon repairs in zone II using a standard modified Kessler technique only. Patients in Group A had a higher proportion of excellent results (on the modified Strickland system) and more movement in the distal interphalangeal joint than the patients in Group B.

A Modified Kleinert Controlled Mobilization Splint Following Flexor Tendon Repair

1984 ◽  
Vol 9 (2) ◽  
pp. 217-218 ◽  
Author(s):  
P. G. SLATTERY ◽  
D. A. McGROUTHER
Keyword(s):  
Range Of Motion ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Interphalangeal Joint ◽  
Flexor Digitorum Profundus ◽  
Distal Interphalangeal Joint ◽  
Normal Range ◽  
Flexor Tendon Repair ◽  
Distal Interphalangeal ◽  
Flexor Digitorum

The Controlled Mobilization Splint as described by Kleinert for use following flexor tendon repair has been modified to more closely simulate the normal range of motion of the fingers and in particular to increase the range of motion at the distal interphalangeal joint and so enhance the relative gliding of the flexor digitorum superficialis and flexor digitorum profundus tendons and hence possibly to reduce potential intertendinous adhesions.

Surmounting the Learning Curve of Core Suture Placement with Tendon Repair Simulator

2018 ◽  
Vol 23 (02) ◽  
pp. 217-220
Author(s):  
Renita Sirisena ◽  
Amitabha Lahiri ◽  
Alphonsus Khin-Sze Chong ◽  
Tun-Lin Foo
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Pass Rate ◽  
Main Criterion ◽  
Flexor Tendon Repair ◽  
Proposed Model ◽  
Similar Criterion ◽  
Group A ◽  
Group B ◽  
Suture Placement

Background: Attaining competency in placement of core suture with adequate distance from juncture is a key skill for learners of tendon repair. Currently, this is most commonly practiced on animal models in wet laboratory environment. To improve accessibility and availability, we developed a tendon repair trainer that aims to guide learners in obtaining this key competency. Methods: A customized tendon dock was designed and manufactured with additive method that permits insertion of 6mm silicon tendon rods to simulate flexor tendon repair along a digit. Four residents, divided into two groups, were instructed to repair two sets of tendon rods (60 rods per resident) with Kessler suture loop placed at 10 mm from juncture (Group A: rods marked at 10 mm, Group B: unmarked rods). The main criterion for passing was a loop placed within 1 mm of the target distance (10 mm). At a second session, both groups repaired unmarked tendons, and these were marked based on similar criterion. Results: At the first session, 100% of those who repaired marked rods (Group A) passed while 25% of unmarked rods (Group B) attained a pass. At the second session, where both groups repaired unmarked rods, residents from group A achieved a pass rate of 95% while group B achieved 33.3% pass. Conclusions: Learners who had previously repaired marked rods were able to retain their experience when repairing unmarked rods. This suggest that the proposed model may be a helpful adjunct to sharpen learners’ skills prior to practicing tendon repairs in more costly animal or cadaveric models.

Motion-stable flexor tendon repair with the Mantero technique in the distal part of the fingers

2009 ◽  
Vol 35 (1) ◽  
pp. 51-55 ◽  
Author(s):  
P. Schaller ◽  
W. Baer
Keyword(s):  
Distal Part ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Joint Function ◽  
Range Of Movement ◽  
Flexor Tendon Repair ◽  
Realistic Assessment ◽  
Distal Interphalangeal ◽  
Flexor Digitorum

Lacerated flexor digitorum profundus (FDP) tendons in zone 1 and distal zone 2 were reconstructed in 73 consecutive cases using the motion-stable Mantero technique during a 7-year period. Sixty-five (89%) of these patients were re-examined an average of 40 (26–82) months postoperatively. According to Moiemen and Elliot (2000) assessment by Strickland's original and modified criteria and in addition the Buck-Gramcko score showed excellent and good results of 54%, 72% and 91% respectively. In contrast, examination of the results measuring the range of movement of the distal interphalangeal (DIP) joint alone provided a more realistic assessment in DIP joint function after Mantero technique with excellent and good results of only 38%.

A2 PULLEY INTEGRITY AND THE STRENGTH OF FLEXOR TENDON REPAIR: A BIOMECHANICAL STUDY IN A CHICKEN MODEL

Hand Surgery ◽  
2015 ◽  
Vol 20 (01) ◽  
pp. 11-17 ◽  
Author(s):  
Marc J. Langbart ◽  
Constantine M. Glezos ◽  
Belinda J. Smith ◽  
Elizabeth C. Clarke ◽  
Richard D. Lawson ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Interphalangeal Joint ◽  
Flexor Digitorum Profundus ◽  
Distal Interphalangeal Joint ◽  
Flexor Tendon Repair ◽  
Pull Out ◽  
A2 Pulley ◽  
Distal Interphalangeal ◽  
Joint Flexion

Purpose: This study assesses the influence of A2 pulley integrity on the strength of the repair. Method: Part 1- The flexor digitorum profundus (FDP) tendons of 72 Cobb chicken feet were severed and repaired in the region of the A2 pulley using a modified Kessler core suture and an epitendinous suture. The A2 pulley was either left intact, divided for 50% of its length, or divided in its entirety. The distal interphalangeal joint was fixed at a position of 20°, 40° or 60° of joint flexion. The load to failure, integrity of the A2 pulley and the site of tendon failure were analysed. Part 2- A further 32 chicken feet were used to exclude the effects of freezing and thawing on results and to analyse differences when using a core suture only. Results: No difference in failure load between any of the test groups or subgroups was identified. The integrity of the A2 pulley was preserved in all specimens. The most common cause of failure was distal suture pull-out. Discussion: This study does not demonstrate that release of the A2 pulley provides an advantage in increasing tendon repair strength. Division of 50% of the A2 pulley does not predispose to pulley rupture. Flexor tendon repair strength did not alter with distal interphalangeal joint flexion between 20° and 60°. Clinical Relevance: The findings of this study do not support division of the A2 pulley to prevent flexor tendon repair failure if repair methods of appropriate strength are utilised.

Incidence of tenolysis and features of adhesions in the digital flexor tendons after multi-strand repair and early active motion

2018 ◽  
Vol 44 (4) ◽  
pp. 354-360 ◽  
Author(s):  
Koji Moriya ◽  
Takea Yoshizu ◽  
Naoto Tsubokawa ◽  
Hiroko Narisawa ◽  
Yutaka Maki
Keyword(s):  
Flexor Tendon ◽  
Full Range ◽  
Tendon Repair ◽  
The Other ◽  
Flexor Digitorum Superficialis ◽  
Flexor Tendon Repair ◽  
Level Of Evidence ◽  
Active Motion ◽  
Active Mobilization ◽  
Flexor Digitorum

We report seven patients requiring tenolysis after primary or delayed primary flexor tendon repair and early active mobilization out of 148 fingers of 132 consecutive patients with Zone 1 or 2 injuries from 1993 to 2017. Three fingers had Zone 2A, two Zone 2B, and two Zone 2C injuries. Two fingers underwent tenolysis at Week 4 or 6 after repair because of suspected repair rupture. The other five fingers had tenolysis 12 weeks after repair. Adhesions were moderately dense between the flexor digitorum superficialis and profundus tendons or with the pulleys. According to the Strickland and Tang criteria, the outcomes were excellent in one finger, good in four, fair in one, and poor in one. Fingers requiring tenolysis after early active motion were 5% of the 148 fingers so treated. Indications for tenolysis were to achieve a full range of active motion in the patients rated good or improvement of range of active motion of the patients rated poor or fair. Not all of our patients with poor or fair outcomes wanted to have tenolysis. Level of evidence: IV

Gross and Histological Analysis of Healing After Dog Flexor Tendon Repair with the Teno Fix™ Device

2006 ◽  
Vol 31 (5) ◽  
pp. 524-529 ◽  
Author(s):  
B. W. SU ◽  
F. J. RAIA ◽  
H. M. QUITKIN ◽  
M. PARISIEN ◽  
R. J. STRAUCH ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Weight Bearing ◽  
Tendon Repair ◽  
Tendon Healing ◽  
Full Weight Bearing ◽  
Cast Immobilization ◽  
Flexor Tendon Repair ◽  
The Common ◽  
Flexor Digitorum

The purpose of this study was to examine the in vivo characteristics of the stainless-steel Teno Fix™ device used for flexor tendon repair. The common flexor digitorum superficialis tendon was transected in 16 dogs and repaired with the device. The animals were euthanized at 3, 6, or 12 weeks postoperatively. Difficulties with cast immobilization led nine of 16 animals to be full weight bearing too early, leading to rupture of their repairs. The seven tendons with successful primary repairs (gap <2 mm) underwent histological examination. This in vivo study demonstrates that use of the Teno Fix™ in “suture” of dog flexor tendons did not lead to scarring at the tendon surface, does not cause an inflammatory reaction within the tendon and does not interfere with tendon healing.

Finger zone II flexor tendon repair in children (5–10 years of age) using three ‘figure of eight’ sutures followed by immediate active mobilization

2011 ◽  
Vol 36 (4) ◽  
pp. 291-296 ◽  
Author(s):  
Mohammad M. Al-Qattan
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Early Mobilization ◽  
Final Outcome ◽  
Study Group ◽  
Flexor Tendon Repair ◽  
Active Mobilization ◽  
Zone Ii ◽  
Adult Rehabilitation

For children between 5–10 years of age with zone II flexor tendon lacerations, the literature recommends a modified early mobilization programme under the supervision of a hand therapist but the fingers are immobilized between physiotherapy sessions. We report on a series of children between 5–10 years of age with flexor tendon lacerations (n = 54 fingers) in zone II repaired with a six-strand core suture (three separate ‘figure of eight’ sutures) and actively mobilized immediately after surgery similar to adult rehabilitation programmes with no immobilization between the physiotherapy sessions. The average follow-up for the study group was 13 months (range 7–25 months). There were no ruptures. The final outcome was excellent in 46 fingers (85%) and good in the remaining eight fingers (15%) using the Strickland–Glogovac criteria.

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