Why is it important to protect my repaired tendon s. Infection this is unusual in the hand less than 1% of cases if the wounds. With severe laceration, tendon exposure and swelling maybe observed. Terms should be explained standard protocols employ a dorsal shell with the wrist, mcps, and ips flexed. A torn or cut tendon in the forearm, at the wrist, in the palm, or along the finger will make it impossible to bend one or more joints in a finger.
Perform some important tendon transfers after viewing dr. Aartelonrtelon tissue reinforcementtissue reinforcement ttibialis anterior tendon repairibialis anterior tendon repair ccase reportase report introduction the tibialis anterior muscle passes along the front of the lower leg. The repair will be weak and will require protection in a thermoplastic splint to prevent movements and activity that will risk rupturing your tendon. Tendon injury repair, tendon structure and replacement, xrepair.
More recent tendon repair descriptionshaveemployednonabsorbablemonofilament materialasthesutureofchoice. Advice and exercises following your flexor tendon repair patient information clinical and diagnostic services centre hand therapy your flexor tendons bend your fingers. Gallandkirby patellar tendon repair postsurgical rehabilitation protocol postop days 1 14 dressing. Flexor tendon repair by john gray seiler iii, md during the last 20 years there have been signi. Using a survival animal model and early passive digital mobilization, gelberman et al assessed the influence of flexor sheath continuity on the results of flexor tendon repair. Patient information flexor tendon repair amazon s3. Your wound will be longer than your original injury to allow the.
Flexor tendon repair therapy protocol 2 of 5 o active digital extension with wrist flexed o fds blocking to uninvolved digits and tendons o fdp blocking to uninvolved digits, if fdp is not involved o 10 times, each, every 2 hours scar management. Mar 05, 2016 a series of changes of primary treatment of divisions of the flexor pollicis longus tendon were carried out in the st. The damaged or torn ends of the tendon are sewn together. Flexor tendon repair protocol zones iiii early active. Because flexor tendons are very close to the surface of the skin, a deep cut will most likely hit a flexor tendon. If your flexor tendons are damaged, youll be unable to bend one or more fingers. These tendons enable you to bend your fingers and thumb. Mar 03, 2015 pdf tendon is a crucial component of the musculoskeletal system. Flexor tendon repair protocol zone 25 brigham and womens. Flexor tendon injury the british society for surgery of the. Overview of hand surgery health encyclopedia university. An overview of the management of flexor tendon injuries. During the last 20 years there have been significant innovations in injury repair and aftercare for patients who sustain zone 2 flexor tendon injuries.
A dorsal blocking splint obs is fitted to be worn at all times except during the active. Tendon repair is a difficult surgery because of the structure of the tendon. There are currently two different absorbable barbed suture products available, vloc and stratafix, and both have not been compared to each other with regard to flexor tendon repair. The flexor tendons run from the muscles in your forearm into the. Primary surgical repair results in better functional outcome compared to secondary repair or tendon graft surgery. In this article we discuss tendon injuries in terms of approach to repair beginning at the time of diagnosis through to the rehabilitation programmes and outcome measures commonly used in the uk. Animal and cellular models have been developed to study tendoncell. Tensile strength of tendons decreases from days 5 to 15. Nov 17, 2015 hand rehabilitation after flexor tendon repair 1. Aug 21, 2014 barbed suture material offers the possibility of knotless flexor tendon repair, as suggested in an increasing number of biomechanical studies. In these cases, the tendon is often cut into two pieces. For more distal injuries zones 14 the tendon is flat. Fashion a shortarm splint holding the wrist in 30 degrees of extension and the mp joints.
Tendon disorders of the hand american association for hand. Nov 26, 2018 early repair has evolved as the mainstay of treatment for flexor tendon injuries. Flexor tendon repair therapy protocol sideline orthopedics. To minimize swelling, you must keep your hand lifted up to your shoulder level. Flexor tendon repair protocol zone i passive motion. Walant anesthesia, strong sutures, a slightly bulky repair, intraoperative testing of active movement, and judicious venting of the a2 and a4 pulleys improve results in flexor tendon repair. Dorxiflexionplantar flexion exercises ii intermediate phase. You will not be able to use your hand for any activity for the first 5 weeks as the tendon repair is not strong enough. While wearing your splint you will need to check your skin for red or sore areas and inform.
Approximate timescales for returning to activity 6 weeks 8. Change dressing, keep wound covered, continue ted hose pod 710. To improve circulation in the hand, which is necessary for tendon healing to create a stronger tendon repair to help to reduce swelling to regain functional use of your hand. Remove protective splint making sure to keep hand postured in a protective position. Pdf flexor tendon repair postoperative rehabilitation. Procedure specific hand cpm therapy flexor tendon repair 1,2,5,6,7,8,9,10,12,16,17,18,21 setup if possible the patient should be instructed on hand cpm use. Remove postop dressings within 1 to 3 days postop wound care and edema reduction techniques as needed fabricate thermoplastic dorsal blocking splint o wrist at 30 degrees flexion o mp joints at 50 degrees flexion o ip joints at neutral. If your extensor tendons are damaged, youll be unable to straighten one or more fingers.
Functional outcomes after flexor tendon repair of the. The repair strength is the most important factor as the main function of the tendon is to transmit force, hence a repair must withstand the high forces applied by early active mobilisation15. Severe edema increases tendon drag and likelihood of rupture. Read more about recovering from hand tendon repair and the complications of hand tendon repair. Remove postop bulking dressings, inspect the wound and replace with a light dressing. The purpose of this study was to evaluate both suture materials. Flexor tendon repair, functional outcomes, hand function.
It takes 12 weeks for the tendon to return to full strength. Bakkers postop protocol important instructions following surgery. Strong digital flexor tendon repair, extensionflexion test, and. If you have any reason to suspect that your tendon repair has ruptured, please present to the department.
The acute injuries are usually a result of trauma including many sports injuries, whereas chronic injuries are a result of accumulation of small repetitive failures within the tissue that fail to heal. Feb 23, 2012 since the first flexor tendon repair was described by kirchmayr in 1917, several approaches to flexor tendon injury have enabled successful repairs rates of 7090%. Patient information flexor tendon repair this sheet answers common questions about a flexor tendon repair. Tendon adhesions even with your best efforts and the help of the hand therapists extensor tendon repairs show an extreme tendency to stick to the surrounding tissues. There are a number of factors that have been shown to affect the outcomes of tendon repair. Flexor tendon primary repair strong surgical repair core sutures flexor pulley pulley venting surgical techniques rehabilitation key points primary or delayed flexor tendon repairs in the hand have become standard practice over the past 30 years. In the setting of a failed early repair or conditions in which early repair is not feasible, a delayed reconstruction remains a viable option to restore function to the affected digit. Placehold digital flexion with wrist extended in hook, straight and full fist positions. Flexor tendon repair protocol zone i passive motion 0 to 3 weeks postop. Aartelonrtelon tissue reinforcementtissue reinforcement. Occasionally this requires more surgery later on to try and free up the repair tendon to glide again. The epidemiology of reoperation after flexor tendon repair.
Flexor tendon repair protocol zones iiii early active, modified duran program. Andrews unit in a total of 216 thumbs over 18 years in an attempt to reduce the rupture rate from the initial high level of 17%. A cut in any of these tendons is a serious injury and will require. Local anesthesia immediate area of the surgery is painfree regional anesthesia local and surrounding areas are painfree general anesthesia asleep and painfree the surgeon makes a cut on the skin over the injured tendon. Tendon injuries can occur due to infection, injury, or sudden rupture. Primary repair of the flexor pollicis longus tendon plastic. Make decisions on flexor tendon repair based on current evidence.
While adhesions obliterated the space between the tendon surface and the tendon sheath of the immobilized repairs, the mobilized tendons demonstrated coverage of the repair site by cells from the epitenon by 10 days, and a smooth, gliding surface that was maintained free of adhesions through 42 days. The flexor digitorum profundus fdp tendon or flexor pollicis longus. Flexor tendon repair therapy protocol 3 of 5 continue dbs, unless patient shows unresponsive flexion lag watch for pip flexion contracture. In some cases, it isnt possible to reattach the 2 ends of the ruptured tendon. Alhussein baghdad university alkindy college of medicine 2. In addition, a removable splint is fashioned protecting the a. Finger passive rom flexion of individual pip and dip joints of each digit, followed by composite. Yoke orthosis links the uninjured fingers to the repaired finger. Your tendon will take up to 12 weeks to completely heal and it is important to follow all advice to avoid rupturing your tendon. Therefore, wait until 4872 hours postop prior to initiating rom.
In all cases, a doctor will explain the operation to you and answer any questions you may have. The uninjured fingers in orthosis dynamically assist finger extension that unloads the tendon repair. This will have been done with special stitches both inside and outside the tendon. If you would like further information, or have any particular worries, please do not hesitate to ask your nurse or doctor. Hand tendon repair is carried out when one or more tendons in your hand rupture or are cut, leading to loss of normal hand movements. After your surgery, your tendon is very weak and can break extremely easily. Elevation 252 longer if needed patient not to be discharged until seen by hand physiotherapist or if bank holiday then referred to hand physio next working day with daytime telephone number. A simple flexor tendon repair takes 45 to 60 minutes, but complex surgery for more severe injuries could take much longer. If you do use your hand you are at risk of rupturing the repairs and would then need more surgery. After surgery, your forearm and hand will be in a large bandage and plaster splint. When an outside sharp or blunt force is struck on the plantar surface of the hand, a complete or partial rupture of the flexor tendon andor retinaculum can occur. The wound may be small, but the large forces carried by flexor tendons and the tendency for the repaired tendon to stick to the walls of the tunnel mean that despite a skilled repair and good hand therapy, many fingers do not regain full movement. Tendon injury and repair tendon injuries can be acute or chronic. Finger flexor tendon repair patient postoperative instructions laith alshihabi, md 01 week postop dressings.
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