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Kang A, McKnight RR, Fox PM. Current Concepts: Flexor Tendon Injuries. J Hand Surg Am 2024:S0363-5023(24)00240-5. [PMID: 39093238 DOI: 10.1016/j.jhsa.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 08/04/2024]
Abstract
Flexor tendon injuries are complex, and management of these injuries requires consideration of the surgical timing, injury location, approach, and soft tissue handling. Complications are common, including adhesions, tendon rupture, infection, and a high reoperation rate for zone 2 repairs. Special considerations are given to chronic ruptures, concomitant fractures, and pediatric cases. We discuss current concepts that may improve patient outcomes.
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Affiliation(s)
| | - Richard Randall McKnight
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA; Robert A. Chase Hand and Upper Limb Center, Stanford University Medical Center, Stanford, CA
| | - Paige M Fox
- Robert A. Chase Hand and Upper Limb Center, Stanford University Medical Center, Stanford, CA; Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA; Division of Plastic Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA.
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2
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Chen J, Yang QQ, Tang JB. Healing strength of tendon repair with or without knots between two tendon ends and histological changes in a chicken model. J Plast Reconstr Aesthet Surg 2023; 87:310-315. [PMID: 37925920 DOI: 10.1016/j.bjps.2023.10.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 08/19/2023] [Accepted: 10/07/2023] [Indexed: 11/07/2023]
Abstract
We studied the healing strength and histological changes of digital flexor tendons repaired using Kessler (core suture knots placed over the tendon surface) and modified Kessler (core suture knots placed between two tendon ends) in 31 long toes of chicken. Four weeks after surgery, the healing tendons were measured in a tensile testing machine, and the adhesion formation and histological changes were observed. The strength of the Kessler repairs was significantly greater than that of the modified Kessler repairs with a 35% mean difference. No significant difference was found between the adhesion scores of the tendons repaired with both techniques. In histological sections, the arrangement of collagen fibers in the modified Kessler repair group was more disordered. We conclude that the tendons repaired with the Kessler method are stronger than those with the modified Kessler technique. The knots between tendon ends are detrimental to the early healing strength of digital flexor tendons.
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Affiliation(s)
- Jing Chen
- The Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Qian Qian Yang
- The Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jin Bo Tang
- The Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
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3
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Aljasim O, Yener C, Demirkoparan M, Bilge O, Küçük L, Günay H. Comparison of pulley plasty, pulley venting and resection of flexor digitorum superficialis slip after zone II flexor tendon repair: a cadaver study. J Hand Surg Eur Vol 2023:17531934231215789. [PMID: 38000014 DOI: 10.1177/17531934231215789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
LEVEL OF EVIDENCE V.
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Affiliation(s)
- Omar Aljasim
- Department of Orthopedic Surgery, Gebze Medikal Park Hospital, Kocaeli, Turkey
| | - Can Yener
- Department of Orthopedic Surgery, EMOT Hospital, Izmir, Turkey
| | - Mesut Demirkoparan
- Department of Orthopedic Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Okan Bilge
- Department of Anatomy, Ege University Faculty of Medicine, Izmir, Turkey
| | - Levent Küçük
- Department of Orthopedic Surgery, Medicana International Hospital, Izmir, Turkey
| | - Hüseyin Günay
- Department of Orthopedic Surgery, Ege University Faculty of Medicine, Izmir, Turkey
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4
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Gundlach BK, Zelouf DS. Flexor Tendon Reconstruction. Hand Clin 2023; 39:193-201. [PMID: 37080651 DOI: 10.1016/j.hcl.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Chronic injury to the flexor tendon system of the hand remains a challenging problem for the hand surgeon to treat. Both single- and two-stage techniques remain important in the reconstruction of the flexor tendon deficient digit. Modern advances include the use of allograft composites that aim to reduce the time and donor-site morbidity compared with conventional autograft techniques. Regardless of technique, restoring a gliding tendon-pulley system with a functional arc of motion is the primary goal of flexor tendon reconstruction.
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Affiliation(s)
- Benjamin K Gundlach
- Thomas Jefferson University Hospital. Philadelphia, PA, USA; The Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107, USA
| | - David S Zelouf
- The Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107, USA.
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5
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Tang JB, Pan ZJ, Munz G, Besmens IS, Harhaus L. Flexor Tendon Repair Techniques: M-Tang Repair. Hand Clin 2023; 39:141-149. [PMID: 37080646 DOI: 10.1016/j.hcl.2022.08.015] [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: 04/22/2023]
Abstract
The authors present the methods and outcomes from six institutes where M-Tang repairs with early active flexion exercise are used for zone 2 digital flexor tendon repair. The authors had close to zero repair ruptures, and few digits needed tenolysis. The excellent to good results are generally between 80% and 90%. In the pandemic period, less stringent therapy supervision might have allowed some patients to move too aggressively, with repair ruptures not seen before the pandemic in one institute. In Nantong, Yixing, and Saint John, the rupture incidence is zero to 1%. In Florence and Heidelberg, the rupture incidence was 3%.
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Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
| | - Zhang Jun Pan
- Hand Surgery, Yixing City Hospital, Yixing, Jiangsu, China
| | - Giovanni Munz
- Azienda Ospedaliera Careggi: Azienda Ospedaliero Universitaria Careggi, Surgery and microsurgery of the hand, Largo Palagi 1, Firenze, Italy; Current position is: Unit of hand surgery, Santo Stefano Hospital, via Suor Niccolina Infermiera 22, Prato, Italy
| | - Inga S Besmens
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Switzerland
| | - Leila Harhaus
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Heidelberg, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
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Covino M, Fulchignoni C, Pietramala S, Barbaliscia M, Franceschi F, Maccauro G, Merendi G, Rocchi L. One Year of COVID-19: Lessons Learned in a Hand Trauma Center. J Clin Med 2022; 11:jcm11082163. [PMID: 35456256 PMCID: PMC9024795 DOI: 10.3390/jcm11082163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 12/04/2022] Open
Abstract
2020 will be remembered worldwide as the year of COVID-19 outbreak. The onset of this pandemic abruptly changed everybody’s life and, in a particular manner, doctors’ lives. Our hand surgery department became rapidly one of the first COVID-19-specialized wards in Italy, impacting considerably the authors’ routines and activities. In this paper, the authors focus on how the demographics of patients with hand trauma changed and how they had to modify their activity. The authors retrospectively took into consideration all patients reaching their emergency department (ED) with hand trauma between 9 March 2020 (the day of the beginning of the first lockdown in Italy) and 8 March 2021 and compared them to those who reached the ED in the three previous years. Authors have analyzed the number of patients, their gender and age, the severity of their trauma, where the trauma occurred, the type of lesion, the percentage of patients who underwent surgery, and the percentage of patients who had an emergency admission. In the last year, the number of patients reaching the ED for a hand trauma has been reduced by two thirds (975 patients during the past year), the mean age of those patients has slightly increased, the severity of cases has increased, places of trauma and type of lesions have changed, and, lastly, the percentage of patients needing surgery who were admitted immediately has increased. This paper shows how the type of patients reaching the ED changed and discusses how surgeons evolved and modified their habits in treating those patients during the first lockdown and the year that followed.
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Affiliation(s)
- Marcello Covino
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS—Catholic University of the Sacred Hearth, 00168 Rome, Italy; (M.C.); (F.F.)
| | - Camillo Fulchignoni
- Orthopedics & Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS—Catholic University of the Sacred Hearth, 00168 Rome, Italy; (S.P.); (M.B.); (G.M.); (L.R.)
- Correspondence: ; Tel.: +39-331-788-0630
| | - Silvia Pietramala
- Orthopedics & Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS—Catholic University of the Sacred Hearth, 00168 Rome, Italy; (S.P.); (M.B.); (G.M.); (L.R.)
| | - Marco Barbaliscia
- Orthopedics & Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS—Catholic University of the Sacred Hearth, 00168 Rome, Italy; (S.P.); (M.B.); (G.M.); (L.R.)
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS—Catholic University of the Sacred Hearth, 00168 Rome, Italy; (M.C.); (F.F.)
| | - Giulio Maccauro
- Orthopedics & Traumatology Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS—Catholic University of the Sacred Hearth, 00168 Rome, Italy;
| | - Gianfranco Merendi
- Orthopedics & Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS—Catholic University of the Sacred Hearth, 00168 Rome, Italy; (S.P.); (M.B.); (G.M.); (L.R.)
| | - Lorenzo Rocchi
- Orthopedics & Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS—Catholic University of the Sacred Hearth, 00168 Rome, Italy; (S.P.); (M.B.); (G.M.); (L.R.)
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7
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Qian Yang Q, Chen J. Moving away from original to modified Kessler tendon repair is likely unwise. J Hand Surg Eur Vol 2022; 47:428-429. [PMID: 35000490 DOI: 10.1177/17531934211070699] [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)
- Qian Qian Yang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jing Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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