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Wide-Awake Primary Flexor Tendon Repair, Tenolysis, and Tendon Transfer.

Tang JB - Clin Orthop Surg (2015)

Bottom Line: This method allows the tendon to move actively during surgery to test tendon function intraoperatively and to ensure the tendon is properly repaired before leaving the operating table.I applied this method to primary flexor tendon repair in zone 1 or 2, tenolysis, and tendon transfer, and found this approach makes tendon surgery easier and more reliable.This article describes the method that I have used for tendon surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, China.

ABSTRACT
Tendon surgery is unique because it should ensure tendon gliding after surgery. Tendon surgery now can be performed under local anesthesia without tourniquet, by injecting epinephrine mixed with lidocaine, to achieve vasoconstriction in the area of surgery. This method allows the tendon to move actively during surgery to test tendon function intraoperatively and to ensure the tendon is properly repaired before leaving the operating table. I applied this method to primary flexor tendon repair in zone 1 or 2, tenolysis, and tendon transfer, and found this approach makes tendon surgery easier and more reliable. This article describes the method that I have used for tendon surgery.

No MeSH data available.


Related in: MedlinePlus

Thirty minutes after the local anesthesia injection, the epinephrine takes effect. The skin of the operative field has turned pale. The wound was exposed through a Bruner incision, and the distal half of the A2 pulley was incised through the volar midline. The proximal end of ruptured tendon was found in a small incision in the distal palm and advanced under the preserved A1 and the proximal part of the A2 pulleys. This flexor digitorum profundus tendon shown was repaired with a 6-strand M-Tang technique.
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Figure 3: Thirty minutes after the local anesthesia injection, the epinephrine takes effect. The skin of the operative field has turned pale. The wound was exposed through a Bruner incision, and the distal half of the A2 pulley was incised through the volar midline. The proximal end of ruptured tendon was found in a small incision in the distal palm and advanced under the preserved A1 and the proximal part of the A2 pulleys. This flexor digitorum profundus tendon shown was repaired with a 6-strand M-Tang technique.

Mentions: The flexor digitorum profundus (FDP) tendon is repaired with a 6-strand core suture repair (4-0 suture, M-Tang method using looped suture (Fig. 3),7) such as Supramid (S Jackson, Inc., Alexandria, VA, USA), or a triple Kessler method with asymmetric core suture purchases at two tendon stumps8)) plus a simple running peripheral suture (6-0 suture) (Fig. 4). Core suture purchases should be at least 7 mm, ideally around 10 cm (Fig. 5). This is a very important requirement for the core suture.910) The core suture is performed with some extent of tension to make the two tendon ends approximate tightly to increase gapping resistance, but not too tight to avoid marked tendon bulkiness. It is important to make the repair a bit tensed, rather than being loose or tension-free. My method is to tension the core suture lines to the degree that makes the tendon segments within the core sutures shortened slightly, by approximately 10% (Fig. 5).1112) The lacerated flexor digitorum superficialis (FDS) tendon is repaired when the wound is clean and the repair is easy and the cut is not in the area of zone under the A2 pulley. In many cases, I do not repair the FDS tendon, especially when at delayed primary repair, and when in the A2 pulley area, or when FDS tendon retracted proximally. I have not found that has affected finger function.


Wide-Awake Primary Flexor Tendon Repair, Tenolysis, and Tendon Transfer.

Tang JB - Clin Orthop Surg (2015)

Thirty minutes after the local anesthesia injection, the epinephrine takes effect. The skin of the operative field has turned pale. The wound was exposed through a Bruner incision, and the distal half of the A2 pulley was incised through the volar midline. The proximal end of ruptured tendon was found in a small incision in the distal palm and advanced under the preserved A1 and the proximal part of the A2 pulleys. This flexor digitorum profundus tendon shown was repaired with a 6-strand M-Tang technique.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553273&req=5

Figure 3: Thirty minutes after the local anesthesia injection, the epinephrine takes effect. The skin of the operative field has turned pale. The wound was exposed through a Bruner incision, and the distal half of the A2 pulley was incised through the volar midline. The proximal end of ruptured tendon was found in a small incision in the distal palm and advanced under the preserved A1 and the proximal part of the A2 pulleys. This flexor digitorum profundus tendon shown was repaired with a 6-strand M-Tang technique.
Mentions: The flexor digitorum profundus (FDP) tendon is repaired with a 6-strand core suture repair (4-0 suture, M-Tang method using looped suture (Fig. 3),7) such as Supramid (S Jackson, Inc., Alexandria, VA, USA), or a triple Kessler method with asymmetric core suture purchases at two tendon stumps8)) plus a simple running peripheral suture (6-0 suture) (Fig. 4). Core suture purchases should be at least 7 mm, ideally around 10 cm (Fig. 5). This is a very important requirement for the core suture.910) The core suture is performed with some extent of tension to make the two tendon ends approximate tightly to increase gapping resistance, but not too tight to avoid marked tendon bulkiness. It is important to make the repair a bit tensed, rather than being loose or tension-free. My method is to tension the core suture lines to the degree that makes the tendon segments within the core sutures shortened slightly, by approximately 10% (Fig. 5).1112) The lacerated flexor digitorum superficialis (FDS) tendon is repaired when the wound is clean and the repair is easy and the cut is not in the area of zone under the A2 pulley. In many cases, I do not repair the FDS tendon, especially when at delayed primary repair, and when in the A2 pulley area, or when FDS tendon retracted proximally. I have not found that has affected finger function.

Bottom Line: This method allows the tendon to move actively during surgery to test tendon function intraoperatively and to ensure the tendon is properly repaired before leaving the operating table.I applied this method to primary flexor tendon repair in zone 1 or 2, tenolysis, and tendon transfer, and found this approach makes tendon surgery easier and more reliable.This article describes the method that I have used for tendon surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, China.

ABSTRACT
Tendon surgery is unique because it should ensure tendon gliding after surgery. Tendon surgery now can be performed under local anesthesia without tourniquet, by injecting epinephrine mixed with lidocaine, to achieve vasoconstriction in the area of surgery. This method allows the tendon to move actively during surgery to test tendon function intraoperatively and to ensure the tendon is properly repaired before leaving the operating table. I applied this method to primary flexor tendon repair in zone 1 or 2, tenolysis, and tendon transfer, and found this approach makes tendon surgery easier and more reliable. This article describes the method that I have used for tendon surgery.

No MeSH data available.


Related in: MedlinePlus