Tenolysis after the Reconstruction of PIP Joint of the Finger using Second Toe PIP Joint Free Flap

PURPOSE: The second toe PIP joint free flap is a method of reconstruction used for abnormalities of the PIP joint of the finger. We report the results of the additional tenolysis in patients with a difference between passive ROM and active ROM after second toe PIP joint free flap. METHODS: From March 2001 to July 2008, tenolysis was performed in patients with a difference in their active and passive ROM after second toe PIP joint free transfer, performed on 14 fingers. We performed a retrospective analysis of the medical records, noting the clinical and radiological findings. In addition, we measured the preoperative and postoperative range of motion of the PIP joint. RESULTS: The average active ROM was 22.5degrees in three months after the joint transfer surgery, and was 38degrees after additional tenolysis from five months to twelve months after the joint transfer. CONCLUSIONS: Additional tenolysis, after the second toe PIP joint free flap, might be a good option with an improved results in patients with difference in active and passive ROM of a transferred PIP joint.

Investigation in psychological status and nursing care of patients with hand tenolysis / 中国实用护理杂志

Objective To explore the psychological status of patients after hand tenolysis and the pertinent nursing countermeasures. Methods 47 patients after hand tenolyais were selected and investigated their psychological status and relevant influencing factors with serf-designed questionnaire and symptom checklist-90(SCL-90). Besides, corresponding psychological nursing were applied. The SCL-90 results of Chinese Norm were adopted to undergo comparison with them and t test was chosen. Results On the first day after operation, the score of the investigation objectives was significantly different compared with that of the Chinese norm. After pertinent mental nursing, their symptoms alleviated, and no significant difference was seen between them. Conclusions There are obvious psychological obstacles in patients after hand tenolysis. The pertinent mental nursing has important effect on rehabilitation training and functional rehabilitation after hand tenolysis.

Reconstruction of the Old Flexor Tendon Injury in the Hand / 대한정형외과학회잡지

The old flexor tendon injury in the hand seen after 4 weeks from damage and associated with crushing injury, heavy scarring, fracture and infectious state has the difficulty to deliver the flexor tendon through fibro-osseous sheath and the pulleys. Treatment method depends on the circumstances of the injured flexor tendon and surgeons' judgement. We have treated twenty-three fingers of twenty-three cases, who had old flexor tendon injury, by advancement and tenolysis in 1 each, tendon graft in 5, and staged tendon graft in 16 from March 1989 through February 1994. The result was summarized as follows. 1. The old flexor tendon injury most commonly occurred in the fifth finger(11 cases, 47.8%)and in zone II (16 cases, 69.6%). 2. The most common cause was glass injury(15 cases, 69.6%). 3. 21 of 23 cases(2 thumbs excepted)were evaluated according to the original Strickland system. 14 cases of the staged tendon graft showed excellent(6 cases, 42.9%), good(5 cases, 35.7%)and fair(3 cases, 21.4%). 5 cases of the tendon graft showed excellent(2 cases, 40%), good(1 case, 20%), and fair(2 cases, 40%). 1 case of adhesiolysis and 1 case of advancement showed excellent and good results each. Little difference is observed in the method between the staged graft and tendon graft. 4. The degree of the associated soft tissue injury should be evaluated by the experienced hand surgeon before surgery and the delicate balance between protection and mobilization during the postoperative weeks is important as well as the surgical skill.

Tenolysis in the hand and wrist / 대한정형외과학회잡지

Adhesion around tendons of the hand and wrist and subsequent limitation of motion, is one of the major complications after tendon surgery. In addition to the tendon surgery such as tendon repair or graft, infection, open reduction of fracutres, and burn scar contracture could be the casuses of tendon adhesion. Tenolysis and adequate postoperative rehabilitation program, has been proved to be effective in preventing of adhesion, whatever the cause may be, if its continuity is maintained. In order to evaluate the efficiency and problems of tenolysis, we reviewed 37 fingers of 31 patients who had been treated by tenolysis at Seoul National University Hospital from 1981 to 1991. There were 20 men and 11 women, and the average age was 28.2 years(9-45 years). The causes of adhesion were various; 24 fingers(64%) after tendon repair or tendon graft, 3 fingers(8%) after infection, 4 fingers(10%) after treatment of fracture, 4 fingers(10%) after burn scar contracture, and the other 2 fingers(5%) after curettage of enchondroma. Involved tendon were flexor tendon in 28 fingers and extensor in 9. The average duration of follow-up was 17 months(13 months to 4 years). Active motion of involved finger was started within 2 days after operation. The Total Active Motion(TAM) after operation was average 213°(100°-260°), compared to 123°(40°-180°) before operation. According to Strickland formula which was modified by us, the postoperative results were excellent in 17 fingers, good in 9 fingers, fair in 6 fingers and poor in 5 fingers. In 24 cases who had tenolysis after repair or graft, 19 case(79%) were rated as excellent or good. But in 7 cases whose causes of adhesion were infection or burn scar contracture, only 3 cases(42%) were rated as excellent or good. Compairing the results between younger(less than 30 years of age) and older(more than 30 years of age) group, the younger group showed excellent and good in 8496 and the older group in 41%, The complications were tendon rupture in 3 fingers and minor infection in 2 fingers, respectively. In summary, tenolysis was considered as a useful procedure to improve function of tendon bound down in scar tissue. And the results were better in younger age group(p < 0.05) and in previous tendon repair or graft(p < 0.05) group.

The Use of Long-Acting Anesthetics Through Indwelling Catheter Afer Flexor Tenolysis / 대한정형외과학회잡지

The surgical release of flexor tendons from their restricting adhesions has historically been a somewhat controversial procedure. Especially clinical efficacy of tenolysis is dependent on early active digital motion. The administration of long acting anesthetics (Bupivacaine) through indwelling catheter after tenolysis relieved pain and so achieved early active digital motion in 12 cases. The times for tenolysis following tendon repair and the followup period were 3 months and 6 months on an average. According to flexor zones classification, in 4 patients the lesion was in zone II, 5 in zone III, 1 in zone IV and 2 in zone V. The results were as follows; 1. The functional results after tenolysis showed up 7 excellent, 4 good and 1 fair. 2. The subjective results of the postoperative pain relief showed up 8 excellent and 4 good out of 12 cases.