Endoscopic retrieval of retracted flexor tendons An atraumatic technique (original) (raw)
Related papers
Atraumatic Flexor tendon retrieval- a simple method
Annals of Surgical Innovation and Research, 2013
Zone 2 flexor tendon injuries still represent a challenging problem to hand surgeons despite the well developed surgical techniques and suture materials. Meticulous surgical repair with atraumatic handling of the severed tendon stumps and minimal damage to the tendon sheath are particularly important to prevent postoperative adhesions and ruptures in this area.In zone 2 flexor tendon injuries proximal to the vinculas, the cut ends of the flexor tendons retract to the palm with muscle contraction. To retrieve the severed proximal flexor tendon under tendon sheath and pulley system is very difficult without damaging these structures. Many techniques are described in the literature for the delivery of the retracted proximal tendon stump to the repair site. In this report we would like to present a simple and relatively atraumatic technique that facilitates passing of the retracted flexor tendon through the pulleys in zone 2. We sutured the proximal tendon stump at the distal palmar crease with 3-0 polypropylene suture and used a 14 gauge plastic feeding tube, acting like a conduit for the passage of straightened needle to the finger. We have used this technique 21 times without any complication in our clinic. We have not seen any suture breakage during the passage or needle breakage due to the bending of the needle. We have found this technique is very simple and very effective in retrieving the retracted tendon stump without causing undue damage to the tendon stump or tendon sheath.
Flexor tendon retrieval—another way
The Journal of Hand Surgery: European Volume, 2007
A simple method of flexor tendon retrieval after division in Zones I and II injuries using a silastic urinary catheter is described.
Journal of Clinical Orthopaedics and Trauma, 2019
Flexor tendon injuries have constituted a large portion of the literature in hand surgery over many years. Yet many controversies remain and the techniques of surgery and therapy are still evolving. The anatomical and finer technical considerations involved in treating these injuries have been put forth and discussed in detail including the rehabilitation following the flexor tendon repair. The authors consider, recognition and mastery of these facts form the foundation for a successful flexor tendon repair. The trend is now towards multiple strand core sutures followed by early active mobilization. However, the rehabilitation process appears to be one of the major determinant of the success following a flexor tendon repair. Early mobilization is essential for all the flexor tendon repairs as it is proved to improve the quality of the repaired tendon. The art of achieving the harmony between a stronger repair and unhindered gliding of the repair site through the narrow flexor tendon sheath simultaneously can be mastered with practice added to the knowledge of the basic principles. © 2019 2.2. Pulley system There is a fibrous flexor sheath surrounding the tendon extending from the neck of the metacarpal to the base of the distal phalanx. At certain places, the sheath is thickened, called the pulleys.
Ifssh Flexor Tendon Committee Report
The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 2005
At its most basic, biomechanics is the study of the effects of bending, twisting, pulling, pushing and rubbing (shear) forces on living tissue. These effects provide, as limits, a mechanical description of biological tissue; as they relate to loading experienced in vivo, they describe the mechanical milieu in which living tissues operate. To the extent that the latter affect the former, one can speak of a "Wolff's Law of Soft Tissue", to describe the effect of function on form. Within the realm of hand surgery, no topic exceeds tendon injury and repair in the wealth of biomechanical data available, the thought that has gone into the analysis of that data, and the knowledge that has been gained as a result. This review will summarize the influence of biomechanical thought and research on the management of flexor tendon injury. Conceptually, the loads applied to tendons physiologically become the lower limit for the material properties of the tissue, if it is to function normally. Thus it is relevant to know the tensile strength of normal tendon, of various tendon repairs, and the loads that might be applied to healing tendons either during daily activity or with rehabilitation. Tendon repairs commonly fail by breaking at some point during the healing period. In vitro studies have shown that thicker core sutures, repairs with more strands crossing the laceration, and repairs with locking loops are stronger, and such repairs have been adopted clinically. A running peripheral suture does not increase the ultimate breaking strength much, but does increase the load needed to cause the repair to gap, especially when the running suture is locked. This may be useful as well, for several mechanical reasons discussed below, and on the basis of these mechanical studies, peripheral finishing sutures have been incorporated into tendon repairs, although the details of such sutures remain subject to discussion. Tendon repairs have also been studied in vivo, in animal models. It has been known since the 1940s, when Mason and Allen wrote their classic study, that repairs tend to weaken for the first few weeks, especially in immobilized tendons. More recently, it has become clear that this effect can be moderated considerably if tendons are moved postoperatively, and so early motion regimens have become incorporated into all tendon rehabilitation protocols. Whether loading of the tendon is also important remains controversial. Loading clearly stimulates isolated tendon cells and, in some cases, tendon tissue in vitro, but the results of loading programs in vivo, either in animal models or in clinical studies, have been unimpressive when compared to similar protocols which assure motion, but with minimal loading. Some unanticipated findings have been noted in the studies of partial tendon injuries, which again have influenced clinical practice. For partial lacerations that affect less than 90% of the tendon cross-section, a repair results in a weaker tendon postoperatively than no repair. Even
A Simple, Semirigid, and Surgeon-Friendly Tendon Retriever and Flexor Sheath Dilator
Journal of Hand Surgery-american Volume, 2007
The repair of flexor tendons remains a challenge to the hand surgeon, and zone II repair requires a trained and experienced surgeon for good results. If the tendon has retracted proximally, however, its retrieval through the inflamed and swollen flexor sheath in acute cases and through a shrunken flexor sheath in case of a delayed repair/reconstruction can test any surgeon's skill and patience. Although there are many methods described in the literature for tendon retrieval, most are either not successful or are traumatic to the tendon or its fibrous sheath. We herein describe a semirigid tendon retriever that can be made intraoperatively and is useful in both acute and delayed repairs/reconstructions. The extremely low cost is a special feature. It has been proven to be a simple and effective method of tendon retrieval and also a flexor sheath dilator in delayed repairs/reconstructions. (J Hand Surg 2007;32A: 269 -273.
Chronic flexor tendon lesions – Reconstruction in two stages
2005
A utilização de implantes iniciou-se em 1936, em clássica experiência com tubos de celulóides, na qual observou-se a formação de uma pseudobainha, composta por células adaptadas em aceitar uma estrutura de deslizamento, no caso a estrutura de tendão. Esta técnica não obteve o sucesso esperado, pois sendo o material muito rígido, impedia a mobilização passiva das articulações, resultando em rigidez do dedo. Somente em 1963 é que se iniciou a utilização de espaçadores mais flexíveis, de material tipo silicone
Treatment of flexor tendon injuries: Surgeons' perspective
Journal of Hand Therapy, 1999
R estor ation of digital function following flexor tendon injury continues to challenge the hand surgery and therapy communities. Stiffness and scarring leading to functional impairment continue to frustrate the most experienced surgeons, therapists, and compliant patients. Despite efforts to improve the results of flexor tendon repairs, restrictive adhesions affixing the injured tendon to the flexor tendon sheath continue to compromise functional recovery more than any other problem. Joint contracture and repair rupture present additional obstacles to a successful outcome following repair of flexor tendons. The irreparable tendon and tendon sheath requiring reconstruction remain a troublesome clinical presentation. This paper reviews flexor tendon literature defining today's understanding of the flexor tendon system's response to injury and surgical reconstruction. New techniques will continue to evolve, each having the goal of promoting tendon gliding and limiting postoperative adhesions. As the new millennium approaches, we edge closer to the goal of predictably restoring normal hand function after flexor tendon injury. This paper is followed, on p. 149, by a paper presenting a hand therapist's commentary on the same subject.