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

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

The Aetiology of Acute Rupture of Flexor Tendon Repairs in Zones 1 and 2 of the Fingers During Early Mobilization

1999 ◽  
Vol 24 (3) ◽  
pp. 275-280 ◽  
Author(s):  
S. B. HARRIS ◽  
D. HARRIS ◽  
A. J. FOSTER ◽  
D. ELLIOT
Keyword(s):  
Tendon Rupture ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Early Mobilization ◽  
Active Motion ◽  
Rupture Rate ◽  
Active Flexion ◽  
Flexor Tendon Injuries ◽  
Acute Rupture ◽  
Flexor Tendon Rupture

Five hundred and eight patients with 840 acute complete flexor tendon injuries in 605 fingers in zones 1 and 2 underwent surgery and postoperative mobilization in a controlled or early active motion (active flexion-active extension) regimen over a period of 7.5 years. Sixty-eight patients with 79 finger flexor divisions who did not complete the rehabilitation programme were excluded. Of the 440 patients with 728 complete tendon divisions in 526 fingers included in the study, 23 patients ruptured 28 tendon repair(s) in 23 fingers, an overall rupture rate of 4%. One hundred and twenty-nine fingers with zone 1 injuries had a rupture rate of 5%. Three hundred and ninety-seven fingers with zone 2 injuries had a rupture rate of 4%. This study analyses the 23 patients with flexor tendon rupture(s) to identify causative factors. In approximately half of these patients, tendon rupture followed acts of stupidity. The implications of this are discussed. There was no significant relationship between tendon rupture and the age or sex of the patients, smoking or delay between injury and tendon repair and there was no particular prevalence of zone 2C level injuries among the fingers in which tendon rupture occurred.

MANAGEMENT OF FLEXOR TENDON INJURIES — PART 2: CURRENT PRACTICE IN AUSTRALIA AND GUIDELINES FOR TRAINING YOUNG SURGEONS

Hand Surgery ◽  
2014 ◽  
Vol 19 (02) ◽  
pp. 305-310 ◽  
Author(s):  
Sarah K. Tolerton ◽  
Richard D. Lawson ◽  
Michael A. Tonkin
Keyword(s):  
New Jersey ◽  
Current Practice ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Active Motion ◽  
Polyester Suture ◽  
Active Flexion ◽  
Flexor Tendon Injuries ◽  
Materials Used

Introduction: This study aims to gain a better understanding of current practice for the surgical management and rehabilitation of flexor tendon injuries in Australia, with the intent of establishing common guidelines for training of young surgeons. Methods: A survey was distributed to the membership of the Australian Hand Surgery Society to determine whether a consensus could be obtained for: suture material and gauge; core and epitenon suture techniques; sheath and pulley management; and post-operative protocols for primary flexor tendon repair. Results: The predominant materials used for core suture are TicronTM Suture (Tyco Healthcare Group LP, Norwalk, Connecticut, USA) (34%) and EthibondTM Polyester Suture (Ethicon, Somerville, New Jersey, USA) (24%). The two core suture configurations commonly used are the Adelaide (45%) and Kessler (32%) repair. The predominant materials used for epitendinous sutures are 6-0 ProleneTM Polypropylene Suture (Ethicon, Somerville, New Jersey, USA) (56%), 5-0 ProleneTM (21%) and 6-0 EthilonTM Nylon Suture (Ethicon, Somerville, New Jersey, USA) (13%); and the majority (63%) use a running epitendinous technique. The management of critical pulleys is variable, with 89% prepared to perform some release of A2 and A4 pulleys. Rehabilitation protocols vary widely, with 24% of respondents using the same method for all patients, while 76% tailor their approach to each patient. Some component of active motion was used by most. Discussion: There exists some consensus on the management of flexor tendon injuries in Australia. However, the management of critical pulleys and methods of post-operative rehabilitation remain varied. For the training of young surgeons, a majority advise a 3-0 gauge braided polyester core suture of four strands, combined with a 6-0 ProleneTM simple running epitendinous suture for increased tendon repair strength and smooth glide. Trainees should attempt to retain the integrity of the A2 and A4 pulleys. Post-operative rehabilitation should include a component of active flexion.

Outcomes of staged reconstruction of Zone 2 flexor tendon injuries in recent wide-awake surgical settings and an earlier case series

2021 ◽  
pp. 175319342110532
Author(s):  
Ahmed Fathy Sadek ◽  
Ahmed Sobhi Hweidi ◽  
Mohamed Atef Ahmed
Keyword(s):  
Flexor Tendon ◽  
Case Series ◽  
Tendon Injuries ◽  
Level Of Evidence ◽  
Active Motion ◽  
Flexor Tendon Injuries ◽  
Total Active Motion ◽  
In Series ◽  
Expertise Level ◽  
Wide Awake

We report outcomes of patients who were managed with two-stage tendon grafting for neglected Zone 2 flexor tendon injuries from 2012 until 2019. The patients were divided into two cohorts: recent series (Series 1) included patients treated with local anaesthesia and epinephrine (16 fingers, from 2015), and earlier series (Series 2) included patients treated with either general or local intravenous anaesthesia and tourniquet (12 fingers, before 2015). The patients in Series 1 achieved statistically better mean total active motion of the operated fingers and grip compared with the contralateral hand than the earlier series ( p = 0.03, p = 0.01, respectively). With the Tang grading system, excellent and good results were achieved in 13 and six fingers of the patients in Series 1 and Series 2, respectively. We conclude that wide-awake second stage of staged flexor tendon grafting provides fine-tuned adjustment of length and tension of the graft, but we cannot conclude about comparative outcomes between two series because the sample size is small and the earlier series was operated by the same surgeons with lower expertise level. Level of evidence: IV

A Comparative Study of Two Methods of Controlled Mobilization of Flexor Tendon Repairs in Zone 2

1998 ◽  
Vol 23 (1) ◽  
pp. 41-45 ◽  
Author(s):  
F H. PECK ◽  
C. A. BÜCHER ◽  
J. S. WATSON ◽  
A. ROE
Keyword(s):  
Comparative Study ◽  
Prospective Study ◽  
Range Of Motion ◽  
Flexor Tendon ◽  
Primary Repair ◽  
Tendon Injuries ◽  
Matched Pairs ◽  
Motion Group ◽  
Active Motion ◽  
Injury Characteristics

This prospective study compares subjects following primary repair of flexor tendons in zone 2 using either controlled active motion or a modified Kleinert regime. A matched pairs design was employed, subjects being matched for gender, age and injury characteristics. Twenty-six pairs of subjects with 92 tendon injuries in 52 digits were assessed 12 weeks postoperatively in respect of range of motion and dehiscence. Outcomes were defined using the Strickland criteria. No statistically significant differences in respect of range of motion were demonstrated between the groups. Incidence of rupture, however, was significantly less in the modified Kleinert group (7.7%) than in the controlled active motion group (46%).

Flexor tendon injuries

2011 ◽  
Author(s):  
Robert Savage
Keyword(s):  
Patient Care ◽  
Emergency Services ◽  
Flexor Tendon ◽  
Primary Repair ◽  
Tendon Injuries ◽  
Team Work ◽  
Secondary Surgery ◽  
Central Tenet ◽  
Flexor Tendon Injuries ◽  
Tendon Surgery

♦ Restoring continuity to the supple yet high tensile flexor tendon system presents a challenge unique in surgery. Although there is continuing debate about many details of technique, the central tenet of modern flexor tendon surgery is to repair and move the flexor tendons within a few days of injury♦ Knowledge and experience count for everything at all points of patient care beginning with accurate and timely diagnosis. Emergency services should be arranged to relocate these injuries to appropriately trained surgeons and team-work with specialist hand therapists is an essential part of today’s treatment♦ While all flexor tendon surgery is complicated, it is simplest in the newly injured and unscarred digit, and the results of the correctly rehabilitated primary repair appear to be the best attainable♦ However, occasions will arise when secondary surgery will be necessary and the appropriate skills must be learned.

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.

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.

Improved Results in Zone 2 Flexor Tendon Injuries with a Modified Technique of Immediate Controlled Mobilization

1993 ◽  
Vol 18 (1) ◽  
pp. 26-30 ◽  
Author(s):  
L-E. KARLANDER ◽  
M. BERGGREN ◽  
M. LARSSON ◽  
G. SÖDERBERG ◽  
G. NYLANDER
Keyword(s):  
Flexor Tendon ◽  
Primary Repair ◽  
Rubber Band ◽  
Tendon Injuries ◽  
Modified Technique ◽  
Flexor Tendon Injuries

The results following primary and delayed primary repair in zone 2 flexor tendon injuries were evaluated in 85 fingers of 79 patients using immediate controlled mobilization post-operatively. In 31 patients a conventional Kleinert technique was used. In the remaining 48 patients a modified technique was used with rubber band traction to all fingers instead of only to the injured one. Also a shorter dorsal splint was used in order to secure extension of the PIP and DIP joints. The results were improved and the time of treatment was reduced.

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