Elsevier

Hand Clinics

Volume 39, Issue 2, May 2023, Pages 203-214
Hand Clinics

Tenolysis and Salvage Procedures

https://doi.org/10.1016/j.hcl.2022.08.021Get rights and content

Section snippets

Key points

  • •

    Complications in primary flexor tendon repair are common and include tendon rupture, adhesion formation, and joint contracture.

  • •

    Rupture of a repaired tendon should be treated by early operative exploration, debridement, and revision with a four-core strand suture and nonbraided epitendinous suture.

  • •

    Adhesion formation may be mitigated with the use of epitendinous and core sutures, and early postoperative mobilization.

  • •

    Flexor tenolysis should be considered if the range of motion has plateaued and

Flexor tendon scarring

The most common complication following flexor tendon repair prompting revision surgery is adhesion formation, occurring in 4% to 10% of cases.6,45 Reoperation occurs in approximately 6% of flexor tendon repairs and of these, tenolysis is the operation most performed and accounts for more than 50% of revision surgeries. Due to the unique anatomy of the flexor tendons and the surrounding fibro-osseous canal in Zone II, even marginal increases in bulk or slight anatomic changes can translate to

Summary

Despite improvements in our understanding of the physiology and biomechanics of tendon healing, functionally reliable repair of flexor tendon lacerations remains challenging and subject to complications including tendon rupture, adhesion formation, and joint contracture. Timely diagnosis and the adept performance of revision procedures such as primary tendon repair, flexor tenolysis, joint release, and two-staged flexor tendon reconstruction are essential in restoring good functional outcomes.

Clinics care points

  • •

    Complications in primary flexor tendon repair are common and include tendon rupture, adhesion formation, and joint contracture.

  • •

    Rupture of a repaired tendon should be addressed by early operative exploration, debridement, and revision with a four-core strand suture and nonbraided epitendinous suture.

  • •

    Adhesion formation may be mitigated with the use of epitendinous and core sutures, and early postoperative mobilization.

  • •

    Flexor tenolysis should be considered if the range of motion remains suboptimal

Disclosure

The authors have nothing to disclose.

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