ABSTRACT
Flexor profundus lacerations in the distal part of zone I are usually treated by tendon reinsertion into bone. We present a modified technique in which three 'figure of eight' sutures include the palmar plate in the distal purchase. Inclusion of the palmar plate significantly strengthens the tensile strength of the repair and this was confirmed biomechanically in an experimental study. In a prospective clinical study, 15 patients with clean-cut complete lacerations of the profundus tendon in the distal part of zone I underwent the modified repair technique of three separate 'figure of eight' sutures with the palmar plate included in the suture distally and 7 mm suture purchase proximally, with postoperative immediate active motion that ensured full active extension of the interphalangeal joints. There were no ruptures or infections. At final follow-up 12-25 weeks after surgery, the mean range of motion at the distal, proximal, and combined interphalangeal joints was 66 degrees, 100 degrees and 166 degrees respectively. All patients achieved an excellent or good outcome.
Subject(s)
Finger Injuries/surgery , Suture Techniques , Tendon Injuries/surgery , Adolescent , Adult , Animals , Follow-Up Studies , Humans , Middle Aged , Models, Animal , Physical Therapy Modalities , Postoperative Care , Prospective Studies , Range of Motion, Articular , SheepSubject(s)
Acrospiroma/pathology , Precancerous Conditions/pathology , Sweat Gland Neoplasms/pathology , Acrospiroma/genetics , Acrospiroma/surgery , Disease Progression , Humans , Male , Middle Aged , Nails , Precancerous Conditions/genetics , Precancerous Conditions/surgery , Sweat Gland Neoplasms/genetics , Sweat Gland Neoplasms/surgery , Thumb , Tumor Suppressor Protein p53/geneticsABSTRACT
The tensile strength of three different flexor tendon repair techniques were tested in vitro: the modified Kessler technique (a two-strand repair), two 'figure of eight' sutures (a four-strand repair) and three 'figure of eight' sutures (a six-strand repair). The mean breaking forces for the three techniques were 48.0 N, 73.1 N and 93.3 N, respectively, and the differences were highly significant (p < 0.0001). In a prospective clinical study, a total of 45 patients (50 fingers) with clean-cut complete lacerations of both flexor tendons in zone 2 were included. The protocol used the three 'figure of eight' suture techniques for (profundus only) tendon repair, 'venting' of the pulleys, and post-operative immediate active range of motion that ensured full active extension of the proximal interphalangeal joint. One repair (2%) ruptured. In the remaining 49 repairs, the result was considered excellent in 39 (78%) and good in 10 (20%) using the Strickland and Glogovac grading system.
