Flexor tendon surgery: Advances in the field of hand surgery

2012 ◽  
Vol 153 (21) ◽  
pp. 811-820 ◽  
Author(s):  
Vilmos Bíró
Keyword(s):  
Flexor Tendon ◽  
Tendon Healing ◽  
Hand Surgery ◽  
Postoperative Treatment ◽  
Suture Materials ◽  
Flexor Tendon Injuries ◽  
Tendon Surgery ◽  
History Of ◽  
Detailed List ◽  
Near Future

Reconstruction of the flexor tendon injuries is one of the most difficult problems in hand surgery, because the postoperative end-results are often unfavorable. The author discusses the history of the flexor tendon surgery, and then he describes the development of the knowledge regarding the anatomy, the blood supply and the tendon healing of the flexor tendons from the beginning until now. After that he describes the development in suture materials, suture techniques, primary and secondary tendon reconstruction operations, postoperative treatment and rehabilitation programmes. The author describes what kind of progress to be expected in this field in the near future, and then he expresses his viewpoint about the development in the international and national hand surgical societies. He encloses a detailed list of literature for those who are interested in the field. Orv. Hetil., 2012, 153, 811–820.

Flexor tendon injuries

2011 ◽  
Author(s):  
Robert Savage
Keyword(s):  
Patient Care ◽  
Emergency Services ◽  
Flexor Tendon ◽  
Primary Repair ◽  
Tendon Injuries ◽  
Team Work ◽  
Secondary Surgery ◽  
Central Tenet ◽  
Flexor Tendon Injuries ◽  
Tendon Surgery

♦ Restoring continuity to the supple yet high tensile flexor tendon system presents a challenge unique in surgery. Although there is continuing debate about many details of technique, the central tenet of modern flexor tendon surgery is to repair and move the flexor tendons within a few days of injury♦ Knowledge and experience count for everything at all points of patient care beginning with accurate and timely diagnosis. Emergency services should be arranged to relocate these injuries to appropriately trained surgeons and team-work with specialist hand therapists is an essential part of today’s treatment♦ While all flexor tendon surgery is complicated, it is simplest in the newly injured and unscarred digit, and the results of the correctly rehabilitated primary repair appear to be the best attainable♦ However, occasions will arise when secondary surgery will be necessary and the appropriate skills must be learned.

scholarly journals A review of current concepts in flexor tendon repair: physiology, biomechanics, surgical technique and rehabilitation.

2015 ◽  
Vol 7 (4) ◽  
Author(s):  
Rohit Singh ◽  
Ben Rymer ◽  
Peter Theobald ◽  
Peter B.M. Thomas
Keyword(s):  
Flexor Tendon ◽  
Primary Repair ◽  
Functional Anatomy ◽  
Tendon Repair ◽  
Hand Surgery ◽  
Suture Repair ◽  
Flexor Tendon Repair ◽  
Flexor Tendon Injuries ◽  
No Man's Land ◽  
American Society

Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man’s land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into world-wide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biomechanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs.

scholarly journals Flexor Tendon Injuries in the Hand: A UK Survey of Repair Techniques and Suture Materials—Are We Following the Evidence?

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
W. B. J. Rudge ◽  
M. James
Keyword(s):  
Functional Outcomes ◽  
Surgical Repair ◽  
Suture Material ◽  
Flexor Tendon ◽  
Postal Survey ◽  
Current Evidence ◽  
Suture Materials ◽  
Flexor Tendon Injuries ◽  
Repair Techniques

Introduction. Injuries to the hand are common, and poor functional outcomes can have significant long-term consequences affecting both work and social activities. Good outcomes following flexor tendon lacerations in the hand are dependent on a sound surgical repair allowing early active mobilisation. Materials and Methods. We reviewed the literature regarding the choice of suture material and repair technique. We then carried out a nationwide postal survey of plastic surgery hand units to assess the level of compliance with the evidence. Results. Fifty-four units were surveyed. The response rate was 72%, with the most popular core suture being Prolene (64%) and the most popular technique being the Kessler repair (36%). Discussion. Current evidence advocates a multistrand repair using Ethibond. We found that the majority of units are not following the evidence. We suggest the use of evidence-based departmental guidelines to improve the practice and outcomes following these common injuries.

scholarly journals Avoidance of unfavourable results following primary flexor tendon surgery

2013 ◽  
Vol 46 (02) ◽  
pp. 312-324 ◽  
Author(s):  
T. Giesen ◽  
D. Elliot
Keyword(s):  
Flexor Tendon ◽  
Normal Function ◽  
Tendon Injuries ◽  
Clinical Usefulness ◽  
Historical Background ◽  
Unfavourable Outcome ◽  
Future Possibility ◽  
Flexor Tendon Injuries ◽  
Tendon Surgery ◽  
Complex Injuries

ABSTRACTThis review describes the biological problems faced by those managing primary flexor tendon injuries and explains why these problems still thwart attempts to achieve normal, or near normal, function after this injury, despite a century of surgical effort. It considers the historical background of the early 20 th century attempts to improve the results and analyses the clinical usefulness of more recent research into tendon core and circumferential suture modification, including the authors′ work in this field, and changes in post-operative mobilisation over the last 50 years. More recent manipulation of the sheath to improve results and the future possibility of manipulation of adhesions are discussed. It also discusses other factors, e.g., the patient, the experience of the surgeon, the use of therapists, the timing of repair, complex injuries, injuries in zones other than zone 2, which can have a bearing on the results and considers how these can be modified to avoid an unfavourable outcome.

A lactoferrin-derived peptide (PXL01) for the reduction of adhesion formation in flexor tendon surgery: an experimental study in rabbits

2011 ◽  
Vol 36 (8) ◽  
pp. 656-662 ◽  
Author(s):  
M. Wiig ◽  
K. Olmarker ◽  
J. Håkansson ◽  
L. Ekström ◽  
E. Nilsson ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Adhesion Formation ◽  
Rabbit Model ◽  
Sodium Hyaluronate ◽  
Tendon Healing ◽  
Negative Effects ◽  
Active Motion ◽  
Load To Failure ◽  
Tendon Surgery ◽  
Total Active Motion

Injuries to flexor tendons can lead to loss of finger function after healing due to adhesion formation. The aim of this study was to assess the efficacy and safety of the new peptide, PXL01, in the prevention of peritendinous adhesions. The effect of a single intraoperative administration of PXL01 in sodium hyaluronate on mobility of the affected digit after surgery was assessed in a rabbit model by measuring total active motion, metatarsophalangeal–claw distance and resistance to bending the digits. Load-to-failure testing was done in the same specimens to assess tendon healing. The results demonstrated that a single application of PXL01 in sodium hyaluronate significantly improved mobility of the treated digits compared with the digits in which the same surgery was carried out but no treatment was provided. No negative effects on tendon healing were observed in connection with the treatment.

scholarly journals A varrattechnika fejlődése a kéz hajlítóín-sérüléseiben az elmúlt tizenöt esztendő során

2016 ◽  
Vol 157 (6) ◽  
pp. 212-218
Author(s):  
Vilmos Bíró
Keyword(s):  
Clinical Outcomes ◽  
Flexor Tendon ◽  
Suture Technique ◽  
Tendon Injuries ◽  
Suture Techniques ◽  
Suture Materials ◽  
Postoperative Results ◽  
Pulley System ◽  
Wide Range ◽  
Flexor Tendon Injuries

In the reconstruction of hand flexor tendon injuries it is fundamental to select the best suture technique, which makes possible early, active postoperative mobilization and achievement of the best results. The author reviews the development of suture techniques of the flexor tendon injuries during the last fifteen years, and discusses experimental tendon reconstruction results as well as clinical outcomes. The author describes the importance of different tendon suture materials, the significance of the pulley system of the fingers, the stretching between the sutured tendon ends by tendon sutures and, finally, the importance of the moving course in the reconstructed tendon. He states, that the wide-range adoption of the discussed modern tendon sutures would be necessary for better postoperative results. Orv. Hetil., 2016, 157(6), 212–218.

The attachment of intrinsic and extrinsic, mobilized and immobilized adhesion cells to collagen and fibronectin

2011 ◽  
Vol 37 (6) ◽  
pp. 564-572 ◽  
Author(s):  
O. A. Branford ◽  
D. A. Lee ◽  
K. J. Rolfe ◽  
A. O. Grobbelaar
Keyword(s):  
Cell Attachment ◽  
Flexor Tendon ◽  
Zealand White Rabbit ◽  
Tendon Healing ◽  
Collagen Type I ◽  
Matrix Proteins ◽  
Type I ◽  
Tendon Cells ◽  
Flexor Tendon Injuries ◽  
Cell Groups

This study investigated the attachment of intrinsic and extrinsic, mobilized and immobilized adhesion cells to the extracellular matrix. Five New Zealand White rabbit forepaws were dissected to isolate the flexor tendon core, tendon surface and synovial sheath, which were explanted separately. A further 10 animals were subjected to flexor tendon injuries, randomized to either mobilization or immobilization, and adhesions were explanted at 2 weeks. Cell groups were tested for attachment to collagen type-I or fibronectin and morphometric analysis was made. The attachment of intrinsic tendon cells and adhesion cells from mobilized tendons to both matrix proteins was statistically significantly greater than that of extrinsic tendon cells and adhesion cells from immobilized tendons. Adhesion cells from mobilized tendons were statistically significantly more elongated, which may correlate with the deposition of a more organized matrix. Because the synovial sheath cells were least attached to matrix proteins, selective treatments that reduce cell attachment may be used to exclude them, without inhibiting intrinsic tendon healing.

Flexor Tendon Injuries

2018 ◽  
Author(s):  
Chao Long ◽  
Lisa C Moody ◽  
Paige M Fox ◽  
James Chang
Keyword(s):  
Flexor Tendon ◽  
Hand Function ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Surgical Techniques ◽  
Hand Surgery ◽  
Tendon Injuries ◽  
Pulley System ◽  
Rehabilitation Protocols ◽  
Flexor Tendon Injuries

Flexor tendon injuries are common hand injuries that can significantly affect hand function. Treatment of these injuries requires a thorough understanding of the intricate anatomy and biomechanics of flexor tendons. The goals of reconstruction include restoration of tendon continuity, preservation and reconstruction of the pulley system, maximizing tendon gliding, and minimizing adhesion formation. Surgical treatment, in conjunction with postoperative hand therapy, provides enhanced function. This review provides the surgeon with the relevant anatomy, pearls of clinical evaluation, necessary investigative studies, management algorithms, surgical techniques, rehabilitation protocols, and approaches to common complications. It ends with a discussion of basic and translational research currently being undertaken to address the challenges posed by flexor tendon injuries and how this research can potentially advance patient care.   This review contains 16 figures, 5 tables and 55 references Key words: flexor tendon, flexor tendon injuries, flexor tendon reconstruction, flexor tendon repair, hand, hand surgery, injury, surgical technique, tendons

THE EFFECT OF THERMAL PRECONDITIONING OF THE LIMB ON FLEXOR TENDON HEALING

2007 ◽  
Vol 32 (3) ◽  
pp. 289-295 ◽  
Author(s):  
C. HEALY ◽  
K. J. MULHALL ◽  
D. FITZ PATRICK ◽  
E. W. KAY ◽  
D. BOUCHIER-HAYES
Keyword(s):  
Heat Shock ◽  
Flexor Tendon ◽  
Adhesion Formation ◽  
Rabbit Model ◽  
Tendon Repair ◽  
Tendon Healing ◽  
Flexor Tendon Repair ◽  
Treatment Groups ◽  
Tendon Surgery ◽  
Thermal Preconditioning

Thermal preconditioning reduces inflammation by inducing cytoprotective heat shock proteins. We evaluated the role of limb thermal preconditioning in a rabbit model of flexor tendon repair. The treatment groups underwent limb preconditioning by elevating the limb temperature to 41.5 °C for 20 minutes. The animals were sacrificed three and six weeks after flexor tendon repair. Heat shock protein72 expression of the treated limb was measured at 18 hours. Macroscopic analysis demonstrated a significant decrease in adhesion formation in the three week treatment group. The inflammatory infiltrate was significantly reduced for both treatment groups. The difference in ultimate tensile strength was not significant. We conclude that thermal preconditioning of the limb before flexor tendon repair decreases inflammation and adhesion formation in a rabbit model and has the potential to improve clinical outcome of flexor tendon surgery.

Sign in / Sign up

Export Citation Format

Share Document