Dr.Kamil PietrasikCONTACT:
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TENDON REPAIR
Tendons are soft tissue structures transferring force from muscle belly to bone resulting in joint movement.

Extensor tendons located on dorsal surface of the hand are very superficial what makes them susceptible to injury. Extension deficiency depends on level of injury.

Most frequently extensor tendon injuries manifest as:

Method of extensor tendon repair depends on several factors such us: mechanism of injury, level of injury, time from injury and destruction of surrounding tissues. It may vary from simple immobilization to open surgical repair with tendon graft or transfer.

Scar which forms in repaired extensor tendon may limit its movement. Postoperative hand therapy prevents this complication and is mandatory for obtaining good result. Despite meticulous technique employed in tendon repair followed by adequate hand therapy, full extension of the finger may not be restored. If hand therapy is not implemented or conducted in wrong way adhesions of repaired tendon impair its smooth gliding. Additional surgery may be required to resolve this problem.

Repair of extensor tendon is a complex process that requires besides experienced surgeon and hand therapist, co-operative and well-motivated patient. Without these 3 factors final success can not be achieved.

Extensor tendon repair is performed in local anesthesia or regional block of upper extremity.

Patient is discharged home immediately after the surgery.

Hand is splinted in position enabling tendon healing. Appropriate rehabilitation protocols are implemented from post-operative day 2. It must be remembered that repaired tendon strength is weakest from post-operative day 7 to 21. Hand therapist's instruction must be carefully followed.

In post-operative period hand must be kept in elevation till wound heals completely and edema resolves.
Skin sutures are removed 10-14 days after the surgery.

Return to normal activity involving hands is possible after completion of hand therapy what usually takes 8-12 weeks.

Obtained results are good and long lasting in co-operative patients.

Both flexor tendons (superficial and deep) are on fingers within ligamentous sheaths which prevent their bowstringing. Penetrating injuries on palm and digits may result in destruction of  one or both flexor tendons and adjacent structures. Even small, benign-looking skin laceration may cause complex flexor tendon injury. Thus, careful history of the injury and examination must be obtained by hand specialist.

When both flexor tendons are completely lacerated flexion of digit is impossible. In partial injuries some function may be preserved although if untreated it may lead to finger dysfunction.

Because ends of completely lacerated flexor tendon move in opposite directions they must be approximated and repaired.

It can be performed as an emergency procedure within 48 h from injury if wound is not contaminated or delayed if suspicion of wound contamination exists.

In secondary flexor tendon repair simple approximation and suturing is rarely possible. In this cases 2-stage approach is employed. In first step silicon rod is implanted to finger to facilitate formation of soft tissue tunnel for tendon graft performed as secondary surgery.

Repair of flexor tendon(s) is a complex process which requires besides experienced surgeon and hand therapist, co-operative and well-motivated patient. Without these 3 factors final success can not be achieved.

Flexor tendon repair is performed in local anesthesia or regional block of upper extremity.

If tendon graft is required, palmaris longus or plantaris are standard donor tendons which are harvested without causing any functional deficits.

Patient may be discharged home immediately after the surgery.

Hand is splinted in position enabling tendon healing. Appropriate rehabilitation protocols are implemented from next day after the surgery for a period of 6-8 weeks.

It must be remembered that repaired tendon strength is weakest between 7 and 21 day after the,surgery. Hand therapist's instructions must be carefully followed to avoid tendon rupture.

In postoperative period hand must be kept in elevation till wound heals completely and edema resolves.
Skin sutures are removed 10-14 days after the surgery.

Return to normal activity involving hands is possible after completion of hand therapy what usually takes 8-12 weeks.

This short information doesn’t replace medical consultation in the office.

 

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CONTACT: info@drpietrasik.pl, +48 721 838 347
Polish Society of Plastic, Reconstructive and Aesthetic SurgeryPolish Society of Plastic, Reconstructive and Aesthetic Surgery
International Confederation for Plastic, Reconstructive, and Aesthetic Surgery (IPRAS)International Confederation for Plastic, Reconstructive, and Aesthetic Surgery (IPRAS)
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