Management of Flexor Tendon Injuries in Hand

Peculiar anatomy of human hand with flexing fingers and opposing thumb give human beings clear edge over other existing living beings. We use hands for carrying out most of our daily activities. But at the same time this makes our hands vulnerable for getting traumatized. Hand injuries which involve underlying tendons make digits dysfunctional, which in turn affects overall precise functioning of hand. In this chapter we will briefly discuss related surgical anatomy of flexor tendons and associated structures, features of flexor tendon injuries at different zonal levels, surgical methods involved and different post-operative protocols used for management of these flexor tendon injuries

Two stage flexor tendon reconstruction in hand: our experience

Background: Flexor tendon injuries in the digital flexor sheath area (zone II) are the most difficult to treat and remain a focus of both clinical attention and basic investigations. This prospective study was designed to evaluate the results of staged zone II flexor tendon repair.Methods: Seventy digits in thirty five patients were treated by Two Stage flexor tendon reconstruction and followed for an average of one and a half year. The procedure included placing a silicone catheter (cut to desire size) as an active implant and reconstruction of A2, A4 or both pulleys if damaged in first stage. During the second stage (performed three to eight months later), tendon graft replaced the silicone catheter in the pseudo sheath formed around the catheter. The proximal end of the transplanted tendon was fixed with flexor digitorum profundus tendon of respective finger using the Pulvertaft method, and the distal end of the graft was fixedwith the distal stump of respective flexor digitorum profundus tendon. Early controlled motion protocol was instituted in all cases.Results: As per Buck Gramcko scale total active motion obtained was Excellent in 70%, Good in 20%, Fair in 7.1%, and Poor in 2.9% of patients.Conclusions: Flexor tendon reconstruction using two stage tendon reconstructions is an effective way to restore digital tendon function in delayed zone II flexor tendon injuries

Silicone Foley’s catheter as an effective alternative to Hunter’s rod in staged flexor tendon reconstruction of the hand

Context: Staged flexor tendon reconstruction is most suitable treatment method for extensive zone II tendon injuries. The Hunter’s rod used in this procedure is costly and not easily available, which adds to the miseries of both patients as well as treating surgeon. Aims: The aim of this study is to evaluate the results of staged zone II flexor tendon repair using silicone Foley’s catheter as a cheaper and readily available alternative to Hunter’s rod. Settings and Design: This was a prospective study. Materials and Methods: Seventy digits in 35 patients were treated by the staged flexor tendon reconstruction using silicone Foley’s catheter in place of Hunter’s rod, and the patients were followed for an average period of 18 months. Early controlled motion exercise protocol was instituted in all cases. Results: As per the Strickland scale, total active motion obtained was excellent in 70%, good in 20%, fair in 7.1% and poor in 2.9% of patients. Conclusions: Silicone Foley’s catheter is cheaper, easily available and an effective alternative to Hunter’s rod in staged flexor tendon reconstruction procedure, yielding high rates of excellent and good results with fewer complications