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
|
Tang SY. Modified methods attract too much attention before their validation. J Plast Reconstr Aesthet Surg 2024; 88:388-389. [PMID: 38064917 DOI: 10.1016/j.bjps.2023.11.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 01/02/2024]
Affiliation(s)
- Sherry Yq Tang
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.
| |
Collapse
|
3
|
Duru Ç, Yaşar B, Ergani HM, Acicbe O, Utku Ö, Ünlü RE. Outcomes of Wide-Awake Flexor Tendon Repairs in 58 Fingers and 9 Thumbs. J Hand Surg Am 2022:S0363-5023(22)00054-5. [PMID: 35365356 DOI: 10.1016/j.jhsa.2022.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/10/2021] [Accepted: 01/06/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to present the outcomes of wide-awake flexor tendon repairs in zones 1 and 2 in a major hand trauma referral center. METHODS Zone 1 and zone 2 wide-awake flexor tendon repairs performed between August 2018 and March 2020 were analyzed retrospectively. Outcomes were assessed by the original Strickland-Glogovac criteria for fingers and Buck-Gramcko scoring system for thumbs. Further descriptive analysis of the groups according to potential negative factors, such as injury mechanism, concomitant neurovascular injury, and the extent of injury in zone 2, were performed. RESULTS A total of 94 tendons were repaired in 67 digits (58 fingers, 9 thumbs) of the 61 patients included in the study. Satisfactory results were achieved in 89.6% of the fingers and 77.8% of the thumbs. Intraoperative gapping was corrected after active digital extension-flexion test in 1 patient. Rupture was seen in 1 patient for a rate of 1.5%. The tenolysis indication rate was 5.1% for fingers and 11.1% for thumbs. CONCLUSIONS In our series, functional outcome scores, tenolysis, and rupture rates remained similar with findings in the literature. The outcome of a flexor tendon repair is influenced by many factors that cannot be controlled intraoperatively. To assess the effect of performing the repair in a wide-awake setting on the outcome, clinical trials with large patient groups are needed. LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Çağdaş Duru
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara City Hospital, Ankara, Turkey.
| | - Burak Yaşar
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara City Hospital, Ankara, Turkey
| | - Hasan Murat Ergani
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara City Hospital, Ankara, Turkey
| | - Okan Acicbe
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara City Hospital, Ankara, Turkey
| | - Özge Utku
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara City Hospital, Ankara, Turkey
| | - Ramazan Erkin Ünlü
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara City Hospital, Ankara, Turkey; Department of Plastic Reconstructive and Aesthetic Surgery, Sağlık Bilimleri University, Istanbul, Turkey
| |
Collapse
|
4
|
Abstract
In this review I detail the protocol that I use after flexor tendon repair and outline my experience regarding how its framework might be used for other disorders. The early passive-active flexion protocol has a sufficient number of cycles of active flexion in each exercise session, which is at least 40, and ideally 60 to 80. The frequency of exercise sessions may range from 4 to 6 a day, distributed in the morning, afternoon and evening. Increasing the number of daily sessions without a sufficient number of runs in each session is ineffective. In the first 2-3 weeks after surgery, active digital flexion should go through only a partial range. In weeks 4-6, the patient gradually moves through the full range. With modifications, I suggest generalization of the partial-range finger motion to therapy after treating other hand injuries. I consider partial-range active flexion a generalizable working principle for different hand disorders.
Collapse
Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| |
Collapse
|
5
|
Munz G, Poggetti A, Cenci L, Rizzo AR, Biondi M, Pfanner S. Up to five-week delay in primary repair of Zone 2 flexor tendon injuries: outcomes and complications. J Hand Surg Eur Vol 2021; 46:818-824. [PMID: 34139911 DOI: 10.1177/17531934211024435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
Collapse
Affiliation(s)
- Giovanni Munz
- Unit of Surgery and Reconstructive Microsurgery of the Hand, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Andrea Poggetti
- Unit of Surgery and Reconstructive Microsurgery of the Hand, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Luca Cenci
- Unit of Surgery and Reconstructive Microsurgery of the Hand, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Anna Rosa Rizzo
- Unit of Surgery and Reconstructive Microsurgery of the Hand, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Marco Biondi
- Unit of Surgery and Reconstructive Microsurgery of the Hand, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Sandra Pfanner
- Unit of Surgery and Reconstructive Microsurgery of the Hand, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| |
Collapse
|
6
|
Liu Y, Yang H, Wei S, Gong H, Lu Z. [Clinical application of Wide-awake technique in flexor tendon tenolysis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:567-572. [PMID: 33998209 DOI: 10.7507/1002-1892.202012015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To discuss the method and effectiveness of Wide-awake technique in flexor tendon tenolysis. Methods The clinical data of 16 patients (22 fingers) with flexor tendon adhesion treated by Wide-awake technique for flexor tendon tenolysis between May 2019 and December 2019 were retrospectively analyzed. The patients were all male, aged from 18 to 55 years old, with an average of 35 years old. Among them, 4 cases (7 fingers) after replantation of severed fingers, 4 cases (7 fingers) after flexor tendon rupture repair, and 8 cases (8 fingers) after open reduction and internal fixation of proximal fractures. The time from the original operation to this operation was 6-18 months, with an average of 8 months. The visual analogue scale (VAS) score was used to evaluate the patient's pain during local anesthesia (when the first needle penetrated the skin), intraoperative, and 24 hours postoperatively; and the recovery of finger movement was evaluated by total finger joint active range of motion (TAM) evaluation system and Strickland (1980) standard after operation. Results Intraoperative hemostasis and anesthesia were satisfactory, and the patient could fully cooperate with the surgeon in active finger movements. There were different degrees of pain during local anesthesia (VAS score was 2-4), no pain during operation (VAS score was 0), and different degrees of pain after operation (VAS score was 1-8, 9 patients needed analgesics). All incisions healed by first intention after operation. All 16 cases were followed up 9-15 months with an average of 12 months. Finger function was significantly improved, no tendon rupture occurred. At last follow-up, the patients after proximal fracture open reduction and internal fixation were rated as excellent in 4 fingers and good in 4 fingers according to the TAM standard, and both were excellent according to the Strickland (1980) standard; and the patients after replantation of severed fingers and flexor tendon rupture repair were rated as excellent in 4 fingers and good in 10 fingers according to TAM standard, and as excellent in 6 fingers and good in 8 fingers according to Strickland (1980) standard. Conclusion Wide-awake technique applied in flexor tendon tenolysis can accurately judge the tendon adhesion and release degree through the patient's active activity, achieve the purpose of complete release, and the effectiveness is satisfactory; the effectiveness of tendon adhesion release surgery after fracture internal fixation is better than that of patients after tendon rupture suture and replantation.
Collapse
Affiliation(s)
- Yuzhou Liu
- Department of Hand Surgery, Wuxi No.9 Hospital (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Haoyu Yang
- Department of Hand Surgery, Wuxi No.9 Hospital (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Suming Wei
- Department of Hand Surgery, Wuxi No.9 Hospital (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Hao Gong
- Department of Hand Surgery, Wuxi No.9 Hospital (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| | - Zhengfeng Lu
- Department of Hand Surgery, Wuxi No.9 Hospital (Wuxi Orthopedic Hospital), Wuxi Jiangsu, 214062, P.R.China
| |
Collapse
|
7
|
Chen J, Paik AM. Re: Sadek AF. Flexor digitorum profundus with or without flexor digitorum superficialis tendon repair in acute Zone 2B injuries. J Hand Surg Eur. 45, 10: 1034-44. J Hand Surg Eur Vol 2020; 45:1114-1116. [PMID: 32772628 DOI: 10.1177/1753193420945849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Jing Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Angie M Paik
- Department of Plastic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
8
|
Choke A, Rung WY, McGrouther DA, Bin Abd Razak HR. The strengths of one-, two-, and three-weave Pulvertaft tendon repairs. J Hand Surg Eur Vol 2020; 45:1051-1054. [PMID: 32437222 DOI: 10.1177/1753193420926097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We tested the tensile strength of the proximal juncture of tendon grafts with Pulvertaft tendon repairs in 18 cadaveric digital flexor tendons. These tendons were divided into three groups of six: single, two, or three weaves. Each of the interlacing weaves was secured with eight anchoring sutures. The specimens were loaded in a biomechanical tester until failure. The ultimate tensile strength did not show any significant differences across all three groups with statistical power of 0.77. The mean tendon elongation before repair failure showed significant difference at 10 mm (standard deviation (SD) 2), 16 mm (SD 3), and 15 mm (SD 3), respectively. All specimens failed by intra-tendinous pull-out of the weaves. We conclude that the two-weave Pulvertaft construct demonstrated comparable tensile strength to three weaves and tendon elongation was similar when two or three weaves were used.
Collapse
Affiliation(s)
- Abby Choke
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
| | - Wong Yoke Rung
- Biomechanics Laboratory, Singapore General Hospital, Singapore
| | - Duncan A McGrouther
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore.,Biomechanics Laboratory, Singapore General Hospital, Singapore
| | | |
Collapse
|
9
|
Letter to editor: The evidence-base for the management of flexor tendon injuries of the hand: Review. Ann Med Surg (Lond) 2020; 57:351-352. [PMID: 32953095 PMCID: PMC7484963 DOI: 10.1016/j.amsu.2020.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/05/2020] [Indexed: 11/23/2022] Open
|