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    Ten Do Raphy

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    Jauhar Nafies
    (1) Tendon sutures are used to approximate the ends of a tendon or attach a tendon to bone to hold it in place during healing. (2) An ideal tendon repair provides easy suturing, secure knots, minimal gaping, and sufficient strength for early motion. (3) Non-absorbable sutures like polyester are commonly used as they maintain strength longer than other materials. (4) Flexor and extensor tendon injuries are treated differently depending on the zone of injury, with the goal of primary repair and splinting or casting to allow tendon healing.

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    Ten Do Raphy

    Uploaded by

    Jauhar Nafies
    98 views39 pages
    (1) Tendon sutures are used to approximate the ends of a tendon or attach a tendon to bone to hold it in place during healing. (2) An ideal tendon repair provides easy suturing, secure knots, minimal gaping, and sufficient strength for early motion. (3) Non-absorbable sutures like polyester are commonly used as they maintain strength longer than other materials. (4) Flexor and extensor tendon injuries are treated differently depending on the zone of injury, with the goal of primary repair and splinting or casting to allow tendon healing.

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    tendoraphy

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    (1) Tendon sutures are used to approximate the ends of a tendon or attach a tendon to bone to hold it in place during healing. (2) An ideal tendon repair provides easy suturing, secure knots, minimal gaping, and sufficient strength for early motion. (3) Non-absorbable sutures like polyester are commonly used as they maintain strength longer than other materials. (4) Flexor and extensor tendon injuries are treated differently depending on the zone of injury, with the goal of primary repair and splinting or casting to allow tendon healing.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    98 views39 pages

    Ten Do Raphy

    Uploaded by

    Jauhar Nafies
    (1) Tendon sutures are used to approximate the ends of a tendon or attach a tendon to bone to hold it in place during healing. (2) An ideal tendon repair provides easy suturing, secure knots, minimal gaping, and sufficient strength for early motion. (3) Non-absorbable sutures like polyester are commonly used as they maintain strength longer than other materials. (4) Flexor and extensor tendon injuries are treated differently depending on the zone of injury, with the goal of primary repair and splinting or casting to allow tendon healing.

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    TENDON SUTURE

    BY :

    UKI

    HISTORY
    Mode of injury : sharp objects or blunt
    injury
    Finger position when the injury took place

    PHYSICAL EXAMINATION
    LOOK :
    Position of the injured finger(s)
    Location of the wound

    FEEL : Pain
    MOVE : Range of motion

    Basic Tendon Techniques


    The purpose of tendon suture is :
    - to approximate the ends of a tendon

    - to fasten one end of a tendon to adjoining


    tendons
    - to bone and to hold this position during
    healing.

    Six characteristics of an ideal tendon


    repair :
    (1). easy placement of sutures in the tendon
    (2). secure suture knots
    (3). smooth juncture of tendon ends
    (4). minimal gapping at the repair site
    (5). minimal interference with tendon
    vascularity
    (6). sufficient strength throughout healing to
    permit application
    of early motion
    stress to the tendon.

    SUTURE MATERIAL

    Absorbable sutures (catgut, Dexon, Vicryl), become


    weak too early after surgery to be effective in tendon
    repair.
    Synthetic sutures and nylon maintain their resistance
    to disrupting forces longer than polypropylene
    (Prolene) and polyester suture,
    Polyester sutures (Ticron; Mersilene) provide
    sufficient resistance to disrupting forces and gap
    formation, handle easily, and have satisfactory knot

    FLEXOR TENDON

    ANATOMY

    TREATMENT : Zone I

    TREATMENT : Zone II
    Treated with primary or delayed primary
    repair (2 14 days post injury)
    Both of FDP and FDS repair versus FDP repair
    only
    Extension splinting

    TREATMENT : Zone III


    Treated with primary or delayed primary
    repair (up to 3 weeks after injury)
    Both of FDP and FDS should be repair

    TREATMENT : Zone IV & V


    Primary repair is recommended
    Delayed primary repair should be done
    within 3 weeks of injury

    INCISIONS

    SUTURE TECHNIQUES

    SUTURE TECHNIQUES

    SUTURE TECHNIQUES

    POSTOPERATIVE MANAGEMENT

    COMPLICATIONS
    Zone I : flexion contracture at DIP & PIP,
    tenodesis, detachment
    Zone II V : tendon rupture

    EXTENSOR TENDON

    ANATOMY

    Extensor Tendon Rupture


    For a closed extensor tendon rupture from its
    insertion into the
    distal phalanx, the treatment
    usually is nonsurgical
    -

    - The distal interphalangeal joint is constantly held in


    hyperextension on a splint for 6 to 8 weeks and at
    night only for 1 additional week.

    Acute Transection of Extensor Tendon


    - An open injury of the extensor tendon insertion
    requires repair of the tendon.
    -Extension of the skin laceration proximally required
    to grasp the tendon and mobilize it to its insertion, a
    roll suture usually is sufficient .
    -The repair can be protected with a transarticular
    Kirschner wire.
    -The roll suture is removed after approximately 3
    weeks, the Kirschner wire is removed at
    approximately 4 weeks,
    -The finger is splinted for an additional 4 weeks to
    protect the repair.
    -Progressive motion exercises are commenced and
    continued until maximum function has been
    achieved.

    Roll Stitch
    The roll stitch is especially useful for suturing extensor tendons over or near the
    metacarpophalangeal joints.

    Use a 4-0 monofilament wire or 4-0 monofilament nylon threaded


    on a small, curved needle
    Suture through the skin just medial or lateral to the divided
    tendon
    Through the proximal segment of the tendon near its margin from
    superficial to deep, and then through the deep surface of the
    distal segment, to emerge on its superficial surface.
    Next, pass it proximally and through the opposite margin of the
    proximal segment and bring it out through the skin on the
    opposite side of the tendon . Be certain that the suture slides
    easily in the skin and tendon.
    At about 4 weeks the suture can be removed by pulling on one of
    its ends.

    EXTENSOR INJURIES : Zone I

    Mallet finger = baseball finger


    Classification :

    Type I : closed trauma, loss continuity, small avulsion


    fracture +/Type II : Laceration, DIP, loss continuity
    Type III : Abrasion, loss of skin, subcutaneous cover,
    tendon substance
    Type IV :
    A. Transepiphyseal plate fracture
    B. Hyperflexion injury
    C. Hyperextension injury

    EXTENSOR INJURIES : Zone I


    Treatment of type I Mallet Finger
    Plaster cast : DIP slight hyperextension, PIP 60
    flexion
    Splints : 6 weeks continous splinting, 2 weeks
    night splinting
    K wire fixation : across DIP joint
    External tendon suture
    Direct repair

    EXTENSOR INJURIES : Zone I


    Treatment of type II & III Mallet Finger

    EXTENSOR INJURIES : Zone I


    Treatment of type IV Mallet Finger
    Continous splinting, DIP extension for 3 4
    weeks
    Operative treatment : fracture fragments
    greater than 1/3 articular surface, K wire
    fixation, post op splint

    EXTENSOR INJURIES : Zone I


    Treatment of type IV Mallet Finger

    EXTENSOR INJURIES : Zone II


    Secondary to laceration or crush injury
    Treated by interrupted sutures followed by
    static splinting

    EXTENSOR INJURIES : Zone III


    Boutonniere lesion
    Acute flexion avulsion of central slip
    Treatment of closed Boutonniere deformity:
    Splinting of PIP joint
    Transarticular K wire, PIP joint in full extension

    EXTENSOR INJURIES : Zone III


    Treatment of open Boutonniere deformity

    EXTENSOR INJURIES : Zone IV


    Usually partial lacerations
    Post op : PIP full extension, DIP left free

    EXTENSOR INJURIES : Zone V

    EXTENSOR INJURIES : Zone VI


    Better prognosis than more distal lesions :

    Unlikely have associated joint injuries


    Less potential for adhesion formation
    Greater tendon excursion
    Post op : dynamic splinting

    EXTENSOR INJURIES : Zone VII


    Associated with retinaculum damage
    Nonabsorbable sutures

    EXTENSOR INJURIES : Zone VIII


    Multiple nonabsorbable sutures
    Post op : statis immobilization of the wrist in
    40 45 extension, MCP in 15 20

    POSTOPERATIVE MANAGEMENT

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