1
|
Demers AJ, Moran TE, Bustos FP, Forster GL, Natal E, DeGeorge BR. Revision of Flexor Tendon Repair: Factors Associated With Flexor Tenolysis. Hand (N Y) 2024; 19:664-670. [PMID: 36564984 PMCID: PMC11141425 DOI: 10.1177/15589447221142890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Tenolysis restores mobility to the flexor tendon through the lysis of adhesions that inhibit and negatively impact functional outcomes following flexor tendon repair. Despite extensive literature on operative techniques and therapy protocols used to minimize adhesion formation, there are limited data examining the association of patient, injury, and postoperative factors with tenolysis. This study aims to: (1) quantify tenolysis rates following flexor tendon repair or reconstruction; and (2) identify patient demographic factors, medical comorbidities, injury characteristics, postoperative diagnoses, and complications associated with tenolysis. METHODS PearlDiver was used to identify patients who underwent a flexor tendon repair or reconstruction from 2010 to 2020. Patients were stratified by whether or not flexor tenolysis was performed. Patient demographics, comorbidities, injury characteristics, postoperative diagnoses, and complications were recorded. Logistic regression analysis was used to identify independent risk factors associated with tenolysis. RESULTS Database review identified 10 264 patients who underwent either flexor tendon repair or reconstruction, with 612 patients (6.0%) subsequently undergoing tenolysis. Logistic regression analysis determined that vascular injury preceding flexor tendon repair, surgical wound disruption, nerve injury diagnosed postoperatively, postoperative tendon rupture, and need for repeat flexor tendon repair were associated with an increased odds of tenolysis. Patient age, sex, and comorbidities were not associated with performance of tenolysis. CONCLUSIONS Although tenolysis rates may differ according to physician and patient preferences, identification of factors associated with tenolysis following flexor tendon repair allows surgeons to risk-stratify patients prior to surgery and help guide postoperative expectations if complications arise.
Collapse
|
2
|
Kazantayev KE, Mukhamedkerim KB, Muradov MI, Nabiyev Y, Turdalieva BS. Restoring Function of the Flexor Tendons of the Hand: State of the Science in Kazakhstan. PLASTIC AND AESTHETIC NURSING 2023; 43:219-224. [PMID: 37774170 DOI: 10.1097/psn.0000000000000530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
We conducted a literature review to highlight the diagnosis and treatment of hand flexor tendon injuries and discuss the current state of the science of hand surgery in the Republic of Kazakhstan. We reviewed the Google Scholar, PubMed, Web of Science, Elsevier, and National Center for Biotechnology Information databases and other printed sources for open access articles in three languages. We accepted relevant scientific articles that reflected the peculiarities of restoring function of the tendon flexors of the hand. We reviewed articles from the present to the previous 20 years and included 31 of these sources in our literature review. The medical examination of a patient who has sustained a flexor tendon injury should be thorough and gradual, supported by ultrasound and X-ray examination. For effective restoration of hand function following a hand injury, it is important for the surgeon to conduct a step-by-step assessment of the damage that has occurred to soft tissues, superficial and deep tendons, bones, nerves, and blood vessels. The main goal of tendon repair is to preserve tendon function. It is also known that early postoperative tendon movement leads to faster healing. The most frequent complications associated with flexor tendon repair include the development of adhesions, wound infection, tendon rupture, impaired hand function, and scar formation. Relative to the state of the science in the Republic of Kazakhstan, we conclude that hand surgery should be performed by highly skilled specialists in the field of microsurgery in a specialized department with microsurgical equipment.
Collapse
Affiliation(s)
- Kymbat E Kazantayev
- Kymbat E. Kazantayev, MD, is a Resident Surgeon, Researcher, and Practitioner at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Kanat B. Mukhamedkerim, MD, is a Resident Physician and Public Health and Social Sciences Expert at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
- Mismil I. Muradov, MD, PhD, is a Reconstructive and Plastic Microsurgeon at the Department of Reconstructive and Plastic Microsurgery, Syzganov National Scientific Center of Surgery, Almaty, Republic of Kazakhstan
- Yergali Nabiyev, MD, is a Resident Surgeon at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Botagoz S. Turdalieva, MD, is a Resident Physician and Researcher at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
| | - Kanat B Mukhamedkerim
- Kymbat E. Kazantayev, MD, is a Resident Surgeon, Researcher, and Practitioner at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Kanat B. Mukhamedkerim, MD, is a Resident Physician and Public Health and Social Sciences Expert at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
- Mismil I. Muradov, MD, PhD, is a Reconstructive and Plastic Microsurgeon at the Department of Reconstructive and Plastic Microsurgery, Syzganov National Scientific Center of Surgery, Almaty, Republic of Kazakhstan
- Yergali Nabiyev, MD, is a Resident Surgeon at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Botagoz S. Turdalieva, MD, is a Resident Physician and Researcher at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
| | - Mismil I Muradov
- Kymbat E. Kazantayev, MD, is a Resident Surgeon, Researcher, and Practitioner at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Kanat B. Mukhamedkerim, MD, is a Resident Physician and Public Health and Social Sciences Expert at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
- Mismil I. Muradov, MD, PhD, is a Reconstructive and Plastic Microsurgeon at the Department of Reconstructive and Plastic Microsurgery, Syzganov National Scientific Center of Surgery, Almaty, Republic of Kazakhstan
- Yergali Nabiyev, MD, is a Resident Surgeon at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Botagoz S. Turdalieva, MD, is a Resident Physician and Researcher at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
| | - Yergali Nabiyev
- Kymbat E. Kazantayev, MD, is a Resident Surgeon, Researcher, and Practitioner at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Kanat B. Mukhamedkerim, MD, is a Resident Physician and Public Health and Social Sciences Expert at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
- Mismil I. Muradov, MD, PhD, is a Reconstructive and Plastic Microsurgeon at the Department of Reconstructive and Plastic Microsurgery, Syzganov National Scientific Center of Surgery, Almaty, Republic of Kazakhstan
- Yergali Nabiyev, MD, is a Resident Surgeon at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Botagoz S. Turdalieva, MD, is a Resident Physician and Researcher at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
| | - Botagoz S Turdalieva
- Kymbat E. Kazantayev, MD, is a Resident Surgeon, Researcher, and Practitioner at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Kanat B. Mukhamedkerim, MD, is a Resident Physician and Public Health and Social Sciences Expert at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
- Mismil I. Muradov, MD, PhD, is a Reconstructive and Plastic Microsurgeon at the Department of Reconstructive and Plastic Microsurgery, Syzganov National Scientific Center of Surgery, Almaty, Republic of Kazakhstan
- Yergali Nabiyev, MD, is a Resident Surgeon at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Botagoz S. Turdalieva, MD, is a Resident Physician and Researcher at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
| |
Collapse
|
3
|
Renberg M, Turesson C, Borén L, Nyman E, Farnebo S. Rehabilitation following flexor tendon injury in Zone 2: a randomized controlled study. J Hand Surg Eur Vol 2023; 48:783-791. [PMID: 37066433 DOI: 10.1177/17531934231166336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
The aim of this study was to compare an early active motion (EAM) regimen to a modified Kleinert passive motion therapy in Zone 2 flexor tendon injuries with regards to range of motion (ROM), grip strength and patient-reported outcome measures (PROMs). Seventy-two patients were included. At 3 months postoperatively, we found no difference in total active motion (TAM) between the EAM and the Kleinert groups (median 195.5°, range 115°-273° versus median 191.5°, range 113°-260°), but a significantly better grip strength (median 76%, range 44%-99% versus median 54%, range 19%-101%; p < 0.0005) in the EAM group. Disabilities of the Arm, Shoulder and Hand (DASH) score as well as patient-reported weakness, cold intolerance and problems in daily activities also favoured the EAM group. At 12 months postoperatively, there was no difference in TAM, grip strength or any of the PROMs used. We conclude that EAM leads to a quicker recovery in terms of grip strength and PROMs, but that both regimens lead to similar results at 12 months.Level of evidence: I.
Collapse
Affiliation(s)
- Markus Renberg
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Christina Turesson
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Linda Borén
- Department of Rehabilitation Medicine in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Erika Nyman
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Simon Farnebo
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
| |
Collapse
|
4
|
Newington L, Bamford E, Henry SL. Relative motion flexion following zone I-III flexor tendon repair: Concepts, evidence and practice. J Hand Ther 2023; 36:294-301. [PMID: 37029053 DOI: 10.1016/j.jht.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 04/09/2023]
Abstract
STUDY DESIGN Narrative review and case series. INTRODUCTION The relative motion approach has been applied to rehabilitation following flexor tendon repair. Positioning the affected finger(s) in relatively more metacarpophalangeal joint flexion is hypothesized to reduce the tension through the repaired flexor digitorum profundus by the quadriga effect. It is also hypothesized that altered patterns of co-contraction and co-inhibition may further reduce flexor digitorum profundus tension, and confer protection to flexor digitorum superficialis. METHODS We reviewed the existing literature to explore the rationale for using relative motion flexion orthoses as an early active mobilization strategy for patients after zone I-III flexor tendon repairs. We used this approach within our own clinic for the rehabilitation of a series of patients presenting with zone I-II flexor tendon repair. We collected routine clinical and patient reported outcome data. RESULTS We report published outcomes of the clinical use of relative motion flexion orthoses with early active motion, implemented as the primary rehabilitation approach after zone I-III flexor digitorum repairs. We also report novel outcome data from 18 patients. DISCUSSION We discuss our own experience of using relative motion flexion as a rehabilitation strategy following flexor tendon repair. We explore orthosis fabrication, rehabilitation exercises and functional hand use. CONCLUSIONS There is currently limited evidence informing use of relative motion flexion orthoses following flexor tendon repair. We highlight key areas for future research and describe a current pragmatic randomized controlled trial.
Collapse
Affiliation(s)
- Lisa Newington
- Hand Therapy, Guy's and St Thomas' NHS Foundation Trust, London, UK; MSk Lab, Department of Surgery and Cancer, Imperial College London, Sir Michael Uren Hub, London, UK.
| | - Emma Bamford
- Pulvertaft Hand Unit, King's Treatment Centre, Royal Derby Hospital, Derby, England
| | - Steven L Henry
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA; Ascension Plastic and Hand Surgery, Austin, TX, USA
| |
Collapse
|