Flexor tendon repair: recent changes and current methods

2021 ◽  
pp. 175319342110537
Author(s):  
Jin Bo Tang ◽  
Donald Lalonde ◽  
Leila Harhaus ◽  
Ahmed Fathy Sadek ◽  
Koji Moriya ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Hand Surgery ◽  
Past Experience ◽  
Current Status ◽  
Flexor Tendon Repair ◽  
Clinical Methods

The current clinical methods of flexor tendon repair are remarkably different from those used 20 years ago. This article starts with a review of the current methods, followed by presentation of past experience and current status of six eminent hand surgery units from four continents/regions. Many units are using, or are moving toward using, the recent strong (multi-strand) core suture method together with a simpler peripheral suture. Venting of the critical pulleys over less than 2 cm length is safe and favours functional recovery. These repair and recent motion protocols lead to remarkably more reliable repairs, with over 80% good or excellent outcomes achieved rather consistently after Zone 2 repair along with infrequent need of tenolysis. Despite slight variations in repair methods, they all consider general principles and should be followed. Outcomes of Zone 2 repairs are not dissimilar to those in other zones with very low to zero incidence of rupture.

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.

scholarly journals The influence of duration of Kleinert immobilization on the functional recovery of primarily reconstructed flexor tendons in children and adult patients

2006 ◽  
Vol 53 (3) ◽  
pp. 73-78 ◽  
Author(s):  
J. Jeremic ◽  
C. Vucetic ◽  
Z. Golubovic ◽  
I. Petronic ◽  
K. Jeremic
Keyword(s):  
Functional Recovery ◽  
Functional Disability ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Adult Patients ◽  
Postoperative Adhesions ◽  
Flexor Tendon Repair ◽  
Optimal Balance ◽  
Normal Tendon ◽  
Tendon Ruptures

Flexor tendon repair in the hand is very often complicated by the formation of peritendinous adhesions that result in loss of normal tendon gliding, digital stiffness and functional disability. While stability is critical for a successful tendon repair, mobility is also important, as motion of the repaired tendon decreases the formation of postoperative adhesions and increases the strength of the repair. Immobilization and its duration, can ensure the integrity of the repair but can also lead to scaring, stiffness, and joint contractures. This study included 20 children and 39 adult patients, in the period from January 2000 to April 2003., with flexor tendon ruptures of the hand. Tendons were primary repaired using direct tennoraphy, and postoperately patients were treated with Kleinert dynamic immobilization. The aim of this study was to investigate the influence of the duration of the dynamic immobilization on successful postoperative functional recovery, separately in children and adult patients. Research in this area has been directed at achieving the optimal balance between stability and mobility, without compromising one for the other. .

scholarly journals High-Impact Articles in Hand Surgery

Hand ◽  
2012 ◽  
Vol 7 (2) ◽  
pp. 157-162 ◽  
Author(s):  
Kyle R. Eberlin ◽  
Brian I. Labow ◽  
Joseph Upton ◽  
Amir H. Taghinia
Keyword(s):  
Clinical Studies ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Hand Surgery ◽  
Flexor Tendon Repair ◽  
Level Of Evidence ◽  
Tunnel Syndrome ◽  
Classic Papers ◽  
Highly Cited Articles ◽  
Highly Cited

Background There have been few attempts to identify classic papers within the hand surgery literature. This study used citation analysis to identify and characterize the top 50 highly cited hand surgery articles published in six peer-reviewed journals. Methods The 50 most highly cited hand surgery articles were identified in the Journal of Bone and Joint Surgery (JBJS) American, JBJS British, Plastic and Reconstructive Surgery Journal of Hand Surgery (JHS) American, JHS British/European, and Hand. Articles were evaluated for citations per year, surgical/anatomical topic, and type of study. Clinical studies were further sub-categorized by level of evidence. The distribution of topics was compared with all indexed hand surgery articles. The educational relevance was assessed via comparison with lists of “classic” papers. Results The most common subjects were distal radius fracture, carpal tunnel syndrome, and flexor tendon repair. There was moderate correlation between the distribution of these topics and all indexed hand surgery articles (rho=0.71). There were 31 clinical studies, of which 16 were therapeutic, ten were prognostic, and five were diagnostic. These articles assessed the outcomes of an intervention, described an anatomical/functional observation, introduced an innovation, presented a discovery/classification, or validated a questionnaire. There were only three randomized trials. Using citations per year to control for the influence of time since publication, 36 articles were consistently highly cited. Twenty-three articles were on Stern's Selected Readings in Hand Surgery, considered important in education. Conclusions The top 50 highly cited articles in hand surgery reflect the most common clinical, scientific, and educational efforts of the field.

scholarly journals Ischaemic contracture of the hand

2006 ◽  
Vol 39 (01) ◽  
pp. 94-102
Author(s):  
G. Balakrishnan
Keyword(s):  
Suture Material ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Hypodermic Needle ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Custom Made

ABSTRACTStronger flexor tendon repairs facilitate early active motion therapy protocols. Core sutures using looped suture material provide 1 ½ to twice the strength of Kessler′s technique (with four strand and six strand Tsuge technique respectively). The technique is well-described and uses preformed looped sutures (supramid). This is not available in many countries and we describe a technique whereby looped sutures can be introduced in flexor tendon repair by the use of 23 G hypodermic needle and conventional 4.0 or 5.0 sutures. This is an alternative when the custom made preformed sutures are not available. This can be practiced in zone 3 to zone 5 repairs. Technical difficulties limit its use in zone 2 repairs.

Methods of Evaluation of the Functional Results of Flexor Tendon Repair of the Fingers

1985 ◽  
Vol 10 (1) ◽  
pp. 60-61 ◽  
Author(s):  
A. B. NIELSEN ◽  
P. Ø. JENSEN
Keyword(s):  
Functional Outcome ◽  
Standard Method ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Functional Results ◽  
Functional Evaluation ◽  
Flexor Tendon Repair ◽  
Methods Of Evaluation ◽  
Method Of Measurement ◽  
No Man's Land

The methods used by Buck-Gramcko, Kleinert and Tsuge in evaluating the functional results of flexor tendon repair were each applied to assess the functional outcome in sixty-seven fingers where both tendons had been severed in “no man's land”. The method of Buck-Gramcko gave the highest rating, and the three methods showed evident differences in the results of evaluation after surgery. The study suggests a need for one standard method of measurement and recording, if a comparison of results after flexor tendon repair is to be of value. We found that the method of Buck-Gramcko incorporated the most essential features in the functional evaluation.

Looped suture properties: implications for multistranded flexor tendon repair

2015 ◽  
Vol 40 (3) ◽  
pp. 234-238 ◽  
Author(s):  
R. Haddad ◽  
T. Peltz ◽  
N. Bertollo ◽  
W. R. Walsh ◽  
S. Nicklin
Keyword(s):  
Mechanical Properties ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Relative Effect ◽  
Flexor Tendon Repair ◽  
Polypropylene Monofilament ◽  
Single Suture ◽  
Biomechanical Strength ◽  
Standard Techniques ◽  
Repair Techniques

Multiple-strand repair techniques are commonly used to repair cut flexor tendons to achieve initial biomechanical strength. Looped sutures achieve multiple strands with fewer passes and less technical complexity. Their biomechanical performance in comparison with an equivalent repair using a single-stranded suture is uncertain. This study examined the mechanical properties of double-stranded loops of 3-0 and 4-0 braided polyester (Ticron) and polypropylene monofilament (Prolene). Double loops were generally less than twice the strength of a single loop. Ticron and Prolene had the same strengths, but Ticron was stiffer. The 4-0 double loops had significantly higher stiffness than 3-0 single loops. Increasing the size of sutures had a larger relative effect on strength than using a double-stranded suture. However, a double-strand loop had a larger effect on increasing stiffness than using a single suture of a larger equivalent size. Looped suture repairs should be compared with standard techniques using a thicker single suture.

The effect of flexor tendon repair bulk on tendon gliding during simulated active motion: An in vitro comparison of two-strand and six-strand techniques

2001 ◽  
Vol 26 (5) ◽  
pp. 833-840 ◽  
Author(s):  
David W. Sanders ◽  
Andrew D. Milne ◽  
James A. Johnson ◽  
Cynthia E. Dunning ◽  
Robert S. Richards ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
In Vitro Comparison

scholarly journals Flucloxacillin Reduces Stiffness Following Flexor Tendon Repair

Hand ◽  
2008 ◽  
Vol 3 (4) ◽  
pp. 337-339
Author(s):  
Hagen H. A. Schumacher ◽  
Nick K. James
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Tendon Repair
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