Remove postop bulking dressings, inspect the wound and replace with a light dressing allow wound to breathe. Evaluation and functional assessment of flexor tendon repair in the hand. It would also greatly lessen the chances of your hand recovering fully. Clinical opinions regarding the value of flexor tendon sheath repair have been widely varied. Tendon ends must be debrided direct repair for defects of 12 cm avoid undue tension vy advancement defects 25 cm tendon must be mobile inverted v in. At your first therapy visit, some of your wound dressings may be removed.
Why is it important to protect my repaired tendons. This occurs as a result of gradual wear and tear of the tendon from overuse or aging. Suite 224a blacksburg, va 24060 54055273 postoperative phase i 24 hours to 34 weeks. The patient is positioned supine with the operative extremity prepared and draped on a hand table over a nonsterile tourniquet. Flexor tendons are required to glide large distances to allow the digits full composite flexion and extension, running within a tight pulley system to maximize their efficiency fig. Flexor tendon injuries do not heal by themselves and frequently require surgery to put the injured tendon back to its normal position. Sutures out, dc ted hose when effusion resolved brace x 8 weeks locked in extension for ambulation crutches partial weight bearing pwb. Despite extensive therapy, some patients have longterm stiffness after flexor tendon injuries. Stepbystep demonstration of common flexor tendon repair in right elbow. In all cases, a doctor will explain the operation to you and answer any questions you may have. The flexor tendons muscles are responsible for flexing bending your fingers. Sometimes, a second surgery is required to free up scar tissue and to help the patient regain motion. Remove postop bulking dressings, inspect the wound and replace with a light dressing. Place hold for isolated fds glide of involved digits.
A short informational video for patients recovering from hand surgery affecting their flexor tendon. Gripping can cause the tendon to rupture, which would require another surgery. The tendons on the top of the hand straighten the fingers. Meticulous exposure, careful tendon retrieval, and atraumatic repair are extremely important. Primary repair was deemed unsuitable which led to recommendations to graft, principally to regain finger function3. Early active motion protocol following triple kessler repair.
In 1918, bunnell described his experiences in attempting primary repair of severed flexor tendons in zone ii of the finger. Some authors recommending repair of the membranous tendon sheath. Pdf evaluation and functional assessment of flexor tendon. Bend your wrist with your fingers bent, then straighten your wrist and fingers 12 times. Flexor tendon reconstructions and salvage procedures randall w. Other injuries to the digital flexor tendons are result of tiny tears to the tendon that happen over time. After limb exsanguination with a bandage, a 6cm curved incision is made centered just anterior to the medial epicondyle. When an outside sharp or blunt force is struck on the plantar surface of the hand, a complete or partial rupture of the flexor tendon andor retinaculum can occur. Flexor tendon repair zones iv,v rehabilitation protocol.
Postoperative instructions for flexor tendon repair. Adhesions formed as the repair healed, resulting in total loss of movement in the digit. It is by no means intended to be a substitute for ones. In addition, a removable dorsal blocking splint is fashioned. Despite being a common site for flexor tendon injury, there are few reports on the outcomes of primary tendon repair in zone 5 injuries 55,56. When surgery is required, a splint and hand therapy may be used after the procedure to protect you and to aid in recovery. Physical therapy zones 25 flexor tendon repair protocol timelinesplint therapeutic exercise precautionsother week 3 may initiate serial static pip extension splints at night if needed. Oct 15, 2019 despite being a common site for flexor tendon injury, there are few reports on the outcomes of primary tendon repair in zone 5 injuries 55,56. The repair strength is the most important factor as the main function of the tendon is to transmit force, hence a repair must withstand the high forces applied by early active mobilisation15. Pdf controlled mobilization after flexor tendon repair in. After surgery, the wrist and hand will be in a light dressing or possibly splint.
Full, normal function of the finger is rarely obtained after a flexor tendon injury, but close aher nc tob il. While in the dbs the modified duran exercise program is performed. Patient information flexor tendon repair amazon s3. Remove postop dressings within 1 to 3 days postop wound care and edema reduction techniques as needed fabricate thermoplastic dorsal blocking splint o wrist at 30 degrees flexion o mp joints at 50 degrees flexion o ip joints at neutral. Flexor tendon repairs 6 weeks postoperatively you may now take your splint off and leave it off. Many injuries to the flexor tendons involve lacerations that cut into the tendon. Flexor tendon repair protocol zones iiii early active. Placehold for hook, full and straight fist with wrist extended. Controlled mobilization after flexor tendon repair in zone ii. Typically, any additional injured structures are repaired at the same time as the tendon.
Zone 5 injuries are often associated with concurrent neurovascular compromise which requires surgical intervention and impacts rehabilitation. The adhesions are part of the healing process and almost inevitably produce functional disability following the biological response of the tendon to injury. Finger flexor tendon repair patient postoperative instructions laith alshihabi, md 01 week postop dressings. Walant anesthesia, strong sutures, a slightly bulky repair, intraoperative testing of active movement, and judicious venting of the a2 and a4 pulleys improve results in flexor tendon repair. Flexor tendon injuries can be challenging, especially in zone ii. Why is it important to protect my repaired tendon s. It requires a strong understanding of the anatomy of the tendon sheath and the normal relationship between the pulleys and the flexor digitorum superficialis and flexor digitorum profundus tendons in the digit. Patellar tendon repair revised august 2008 postop days 1 14 dressing pod 1.
Fashion a shortarm dorsal blocking splint with the wrist in 20 degrees of exion, the. It is by no means intended to be a substitute for ones clinical decisionmaking regarding the progression of a. Chief of orthopaedicsurgery brigham and womens faulkner hospital vicechair of clinical operations brigham and womens hospital frontiers in upper extremity surgery tampa, florida november 4, 2017 complications of flexortendonrepair complications of flexortendonrepair. Zone 5 injuries are often associated with concurrent neurovascular compromise which requires surgical intervention and impacts rehabilitation 53. Any repetitive actions are more likely to damage a tendon. Flexor tendon repair or advancement, single, in no mans land. A cut in any of these tendons is a serious injury and will require. Klika flexor tendon repair zones 14 delayed mobilization 1160 kepler drive 1 page green bay, wi 54311 920. The digital flexor tendon of forepaw petmassage training.
If you would like further information, or have any particular worries, please do not hesitate to ask your nurse or doctor. Fabricate and fit the involved hand in a dorsal block splint positioned at. Flexor tendon repair therapy protocol sideline orthopedics. Flexor tendon repair and rehabilitation have posed challenges to surgeons and therapists for decades. These tendons enable you to bend your fingers and thumb. Flexor tendon repair protocol zone i passive motion 0 to 3 weeks postop. Kessler repair for flexor tendon injuries, followed by early active motion rehabilitation. Remove protective splint, making sure to keep wrist postured in a protective positions.
You must follow the instructions given by your doctor and occupational therapist to get the best result from your surgery. Repair of the damaged tendons is necessary to restore normal movement in the wrist and hand. It will take at least 8 weeks following your surgery for the tendons to heal and 12 weeks until you can return to unlimited activities. In contrast, immediate mobilization resulted in signi. The evidencebase for the management of flexor tendon.
Flexor tendon repair protocol zone i passive motion. Prevention of adhesions in surgery of the flexor tendons of. Flexor tendon injuries, however, can be very challenging to treat. Change dressing, keep wound covered, continue ted hose pod 710.
Full, normal function of the finger is rarely obtained after a. Your tendon will take up to 12 weeks to completely heal and it is important to follow all advice to avoid rupturing your tendon. Patient information flexor tendon repair this sheet answers common questions about a flexor tendon repair. Nov 22, 2017 many injuries to the flexor tendons involve lacerations that cut into the tendon. Each finger has two tendons that help to bend the finger into a fist. Long tendons extend from these muscles through the wrist and attach to the small bones of the fingers and thumb. Please fax initial evaluation and progress notes to 815.
Flexor tendon repair zones i ii iii day 23 remove protective splint making sure to keep hand postured in a protective position. Remove postop dressings within 1 to 3 days postop wound care and edema reduction techniques as needed fabricate thermoplastic dorsal blocking splint o wrist at 30 degrees flexion o mp joints at. All flexor tendon injuries need supervised rehabilitation with the therapists for at least 6 weeks and often longer. A dorsal blocking splint obs is fitted to be worn at all times except during the active place and hold exercises. Pdf flexor tendon repair postoperative rehabilitation. A strong repair using at least a 4strand core suture and an associated epitendinous suture will allow for early rehabilitation, which can minimize the risk of adhesion formation. Instructions this is an informedconsent document that has been prepared to help inform you of flexor tendon surgery, its. The repair will be weak and will require protection in a thermoplastic splint to prevent movements and activity that will risk rupturing your tendon. Elbow common flexor tendon repair technique arthroscopy. Peritendinous adhesions after repair of an injury to the digital flexor tendons are a major problem in hand surgery.
Flexor tendon reconstructions and salvage procedures. The most important concern about flexor tendon repair is avoiding use of the injured hand for any type of gripping. Zone 1, fdp flexor tendon repair protocol the intent of this protocol is to provide the clinician with a guideline for the postoperative rehabilitation course of a patient that has undergone a flexor tendon repair. The repair of flexor tendons zones i and ii is a techniqueintensive surgical undertaking. Any loss of range of motion of the finger after flexor tendon repair is an impairment. With severe laceration, tendon exposure and swelling maybe observed. Tendon ends must be debrided direct repair for defects of 12 cm avoid undue tension vy advancement defects 25 cm tendon must be mobile inverted v in gastroc fascia arms of v should be 2x the defect. Active flexor tendon protocol week 0 6 one or more of the tendons that bend your fingers have been repaired. Postoperative instructions for flexor tendon repair purpose of surgery the goal of the operation is to repair or reattach lacerated or detached flexor tendons. In all cases, a doctor will explain the operation to. Flexor tendon repair therapy protocol 3 of 5 continue dbs, unless patient shows unresponsive flexion lag watch for pip flexion contracture. There are a number of factors that have been shown to affect the outcomes of tendon repair. Primary or delayed flexor tendon repairs in the hand have become standard practice over the past 30 years. The repair will be weak and will require protection in a thermoplastic splint to prevent movements and.
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