Risk factors associated with tendon adhesions after hand tendon repair

Jia, Qiyu; Chen, Dongsheng; Guo, Jian; Luo, Xuefeng; Alimujiang, Abudusalamu; Zhang, Jun; Hu, Ningning; Liu, Yanshi; Xie, Zengru; Ma, Chuang

doi:10.3389/fsurg.2023.1121892

Cited by 3 publications

(1 citation statement)

References 42 publications

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“…In our study, this occurred exclusively in zone 2, an area where the tendons are tightly encased within a narrow sheath and accompanied by pulleys as well as aponeurotic structures that facilitate their movement and alignment. When an injury occurs in this area, the resulting development of inflammatory granulation tissue hinders tendon healing; damage to surrounding tissues may negatively affect the essential nutritional supply needed for tendon repair [13]. Therefore, the extensive damage caused by the rupture of both tendons makes it difficult to prevent rerupture.…”

Section: Discussionmentioning

confidence: 99%

Contributing factors to hand flexor tendon rerupture

Koh,

Kim,

Kim

et al. 2024

Arch Hand Microsurg

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Purpose: This retrospective study aimed to identify factors influencing hand flexor tendon rerupture and to develop preventive strategies for patients who have undergone hand flexor tendon repair.Methods: In total, 287 patients who underwent hand flexor tendon repair between January 2011 and June 2022 were included. Patients with thumb injuries, amputations, bone injuries, extensor tendon injuries, and those with less than 3 months of follow-up were excluded. Patients were divided into rerupture and non-rerupture groups. Events leading to ruptures were also investigated. The two groups were compared according to sex, age, occupation, smoking status, history of diabetes mellitus, injury characteristics, core suture method, and timing of the rehabilitation course.Results: Of the 287 patients, 19 experienced rerupture (6.6%). The mean time to rerupture was 25.3 days. Reruptures occurred due to unknown causes in nine cases (47.4%), noncompliance with medical recommendations in seven cases (36.8%), and trauma in three cases (15.8%). Among the investigated factors, little finger injury and concurrent flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) ruptures were significantly associated with rerupture. Little difference was noted in the core suture methods and timing of the rehabilitation course between the two groups.Conclusion: To minimize the risk of rerupture, patients should strictly adhere to medical recommendations and avoid any activities that could cause trauma for at least 1 month after surgery, which is the critical period for tendon remodeling. Patients with little finger injuries as well as concurrent FDS and FDP ruptures require special attention and careful monitoring.

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Section: Discussionmentioning

confidence: 99%

Contributing factors to hand flexor tendon rerupture

Koh,

Kim,

Kim

et al. 2024

Arch Hand Microsurg

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Advances and Challenges in Zone 2 Flexor Tendon Repairs

Wimbiscus,

Sullivan,

Lee

et al. 2024

Ann Plast Surg

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Flexor zone 2 is the area between the A1 pulley at the distal palmar crease to the insertion of the flexor digitorum superficialis tendon at A4 pulley. Termed “no man's land,” primary repair at zone 2 had notoriously high rate of complications such as adhesions, contractures, and tendon rupture. Improved understanding of tendon healing, stronger suture materials, novel operative techniques, judicious pulley venting, and early active rehabilitation have helped improve outcomes. This review examines current methodologies and postoperative considerations for zone 2 flexor tendon repair.

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Vanderbilt University Rehabilitation Approach to Zone 2 Tendon Repairs in the Hand

Stehr,

Wimbiscus,

Sullivan

et al. 2024

Ann Plast Surg

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Zone 2 of the hand, which stretches from the region between the A1 pulley at the distal palmar crease to the insertion of the FDS tendon at the end of the A4 pulley, is notable for its high complication rate following surgery. Many of these complications, such as adhesions, contractures, and tendon rupture, can be avoided through adequate rehabilitation. We document the rehabilitation protocol at Vanderbilt University Medical center, which is characterized by 4 phases. An initial postoperative phase emphasizes shielding the flexor tendons with little motion, a second phase focuses on an orthosis to keep the metacarpophalangeal joints flexed at 45 degrees, a third phase focuses on strengthening exercises, and a fourth phase that focuses on transitioning to normal activities without restriction.

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Risk factors associated with tendon adhesions after hand tendon repair

Cited by 3 publications

References 42 publications

Contributing factors to hand flexor tendon rerupture

Contributing factors to hand flexor tendon rerupture

Advances and Challenges in Zone 2 Flexor Tendon Repairs

Vanderbilt University Rehabilitation Approach to Zone 2 Tendon Repairs in the Hand

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