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
THANK YOU