Predictors of outcome after primary flexor tendon repair in zone 1, 2 and 3

Rigó, István Zoltán; Røkkum, Magne

doi:10.1177/1753193416657758

Cited by 78 publications

(91 citation statements)

References 38 publications

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“…[15] However, our tenolysis rate of 14.4% showed that the adhesion rate was higher than early active motion protocols. [1,11,[16][17][18][19] Tendon gapping during or after the repair may deteriorate the results. The peripheral sutures serve to tidy up the repair site and prevent gapping.…”

Section: Discussionmentioning

confidence: 99%

Tenolysis rate after zone 2 flexor tendon repairs

Ci̇van¹,

Gürsoy

Cavit

et al. 2020

Jt Dis Relat Surg

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Tendon adhesion to surrounding tissues after tendon repair, which is difficult to prevent in clinical practice, is the most common complication reported after tendon repair. [1] Thus, reducing the incidence of adhesion after tendon repair without affecting tendon healing has become a popular research focus. New surgical and rehabilitation techniques are improving the results while an unanimity for the best method has not been obtained. Tendon motion after tendon repair is important to avoid adhesions. Depending on the tendon repair strength, early passive or active flexion exercises may start immediately after the repair. Tendon gapping during or after the repair may deteriorate the results. The peripheral sutures serve to tidy up the repair site and prevent gapping. [2] However, a suture exposure due to complex peripheral suture may lead to adhesion formation and increase gliding resistance during early active motion. [3] Venting pulleys may also decrease the adhesion rate after flexor tendon repair. On the contrary to traditional knowledge about preserving A4 pulley, some authors recommend venting A4 pulley to Objectives: This study aims to evaluate the tenolysis rates of zone 2 flexor digitorum profundus (FDP) with flexor digitorum superficialis (FDS) tendon repairs using four-strand technique and early passive motion exercises. Patients and methods: In this retrospective study, we performed zone 2 flexor tendon repairs in 149 patients (117 males, 32 females, mean age 33.3±12.9 years; range, 13 to 72 years) (82 right and 67 left hands) between November 2014 and January 2019. A total of 194 FDP and FDS tendons were repaired primarily by using modified Kessler and Bunnell methods. Patients underwent pure passive motion protocols after surgery according to modified Duran's protocol. No active flexion components were added until postoperative fourth week. Results: Twenty-three out of 149 patients and 28 out of 194 fingers (14.43%) had tenolysis. There was no significant relationship between the number of operated fingers, gender, and tenolysis rate (p=0.836, p=0.584, respectively). Conclusion: The repair of the FDP with FDS tendon increases the tenolysis rate in zone 2. The tenolysis rate does not change according to the number or distribution of injured fingers and gender of the patient.

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Section: Discussionmentioning

confidence: 99%

Tenolysis rate after zone 2 flexor tendon repairs

Ci̇van¹,

Gürsoy

Cavit

et al. 2020

Jt Dis Relat Surg

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“…68 Semi-urgent cases such as lacerations with tendon or nerve involvement, acute fractures of the hand and wrists, comminuted fractures of the joints should still be performed considering the poor functional outcome if not treated or with a delay in treatment. 72,73 If possible, these procedures should be done in the outpatient setting to minimize utilization of resources. As the virus becomes more prevalent and resources become of more paramount importance, the option for surgery becomes much more limited.…”

Section: Hand Surgerymentioning

confidence: 99%

Plastic Surgery and the COVID-19 Pandemic

et al. 2020

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Background: A novel coronavirus disease (COVID-19) was first reported in December 2019 in China and was soon declared a pandemic by World Health Organization. Many elective and nonessential surgeries were postponed worldwide in an effort to minimize spread of disease as well as to conserve resources. Our goal with this article is to review current practice guidelines in setting of the COVID-19 pandemic, based on available data and literature. Methods: Websites pertaining to surgical and medical societies, and government agencies were reviewed, along with recently published literature to identify recommendations related to COVID-19 and plastic surgery procedures. Results: Clinical practice modifications are recommended during the pandemic, in outpatient and perioperative settings. Use of personal protective equipment is critical for aerosol generating procedures such as surgery in the head and neck area. Care for trauma and malignancy should continue during the pandemic, however definitive reconstruction could be delayed for select cases. Specific recommendations were made for surgical treatment of cancer, trauma and semiurgent reconstructive procedures based on available data and literature. Conclusion: The risk and benefit of each reconstructive procedure should be carefully analyzed in relation to necessary patient care, minimized COVID-19 spread, protection of health care personnel and utilization of resources. Recommendations in this manuscript should be taken in the context of each institute's resources and prevalance of COVID-19 in the region. It should be emphasized that the guidelines provided are a snapshot of current practices and are subject to change as the pandemic continues to evolve.

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“…20 Furthermore, smoking has been previously found to be predictive of poor outcomes following tendon repair. 15 Thus, knowledge of the effects of smoking on tendon health may be effectively used to modify patient behavior preoperatively and may also alter protocols postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Chronic Nicotine Exposure Alters Uninjured Tendon Vascularity and Viscoelasticity

Gittings

Riggin

Boorman-Padgett

et al. 2019

Foot & Ankle Orthopaedics

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Background: Although nicotine and tobacco use are well established to have adverse health effects, the effects on tendons are less well understood. The purpose of this study was to investigate the effect of chronic nicotine exposure on Achilles tendon (AT) and supraspinatus tendon (SS) physiologic and mechanical properties in a rodent model. Methods: Sprague-Dawley rats (n ¼ 20) were exposed to either 0.9% saline or 36 mg/mL nicotine through an implantable osmotic pump for 12 weeks. At 12 weeks, the AT was imaged in vivo with contrast-enhanced ultrasound (CE-US) to assess vascularity. Bilateral AT and SS were then harvested for ex vivo biomechanical analysis. Statistical analysis was performed using Student t test and Mann Whitney U test. Results: AT CE-US demonstrated a significantly increased wash-in rate in the nicotine group compared to the saline group, indicating an increase in tissue perfusion rate in the nicotine group. AT percent stress relaxation, a measure of tendon viscoelasticity, was significantly increased in the nicotine group compared to the saline group. Similarly, there was a trend toward increased SS percent stress relaxation in the nicotine group compared to the saline group. No differences in other mechanical properties were observed. Conclusion: AT perfusion rate increased and both AT and SS viscoelasticity were altered with chronic nicotine exposure at a clinically relevant dose that models the average smoker in the United States (14 cigarettes per day). Further studies are necessary to link these properties with tendon degeneration and injury. Clinical Relevance: Chronic nicotine exposure affects tendon health. Patients should be counseled as such.

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Predictors of outcome after primary flexor tendon repair in zone 1, 2 and 3

Abstract: III.

Cited by 78 publications

References 38 publications

Tenolysis rate after zone 2 flexor tendon repairs

Tenolysis rate after zone 2 flexor tendon repairs

Plastic Surgery and the COVID-19 Pandemic

Chronic Nicotine Exposure Alters Uninjured Tendon Vascularity and Viscoelasticity

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