Flexor tendon injuries_UTSAV

Flexor Tendon InjuriesDr. Utsav Agrawal

Anatomy

Camper’s Chiasma

FDS

FDP

Examination1. Fractures or dislocation2. neurovascular injuries3. Examination of tendon injuries

InvestigationsClinical examinationRadiographyMRI

Timing of surgeryprimary –within 24 hrsDelayed primary -1 to 10 daysSecondary – upto 4 wksLate secondary beyond 4 wks

If wound is clean, primary repair, along with care of neurovascular injury and fracture.

EXPOSURES

Core suturesEpitenon sutures – reduce bulk and increase strength

Core sutures – - careful handling and alignment of tendons - more dorsal suture placement better outcome - More sutures crossing the interaction site, more

strength - lacerations involving more than 60 % cross-section of

the tendon should be repaired - 4-0 braided sutures like capromid, polyester

Suture Configurations

Bunnel Stitch

Kessler Stitch

Masson-Allen Criss-cross

Modified kessler Tajima

Epitenon suture

Tendon to bone attachment

Leddy and Packer classification of FDP avulsion

Leddy type I to be managed as early as possible, atleast within 3 wks

II and III can be managed upto 6 wksIf less than 1 cm distal stump available then

FDP advancement with tendon to bone attachment

in old and leddy I, keep instruments for tendon retrieval like infant feeding tube, paediatric sounds and tendon grafts.

Retrieval technique – sourmelis-mcgrouther

Grafts

Post-operative immobilisation

Complications Adhesion formationImplant failureGraft failurePulley disruptionQuadrigiaLumbrical plus fingerSynovitisInfectionFlexion deformity

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