Artikel
Late primary FDP tendon repair under walant
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Autoren
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Thomas Apard
- Ultrasound Hand Center, Clinique des franciscaines, Versailles, France
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Vanessa Costil
- Ultrasound Hand Center, Clinique des franciscaines, Versailles, France
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Egemen Ayhan
- University of Health Sciences, Diskapi Yildirim Beyazit, Orthopaedics and traumatology, Ankara, Turkey
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: After 21 days, the flexor digitorum profundis (FDP) tendon is so retracted that the surgeon considers there will be too much traction and a bad vascularization of the sliding system (flexion contracture or tendon rupture) to obtain a good result.
The aim fo this clinical study is to blow the myth that you can't repair flexor tendon after 21 days if the tendon is retracted prior to the palm.
Methods: In 2 Hand Surgery Centers, we repair 4 patients (aged 19 to 49 year-old) with injuried FDP tendon with no other complications (no digital nerve injury, no infection, to joint stiffness): one index finger, one 3rd finger and two 5th fingers. The FDP tendon have been checked at the first phalanx by high resolution ultrasonography with Doppler mode. Every patient have been treated under wide awake surgery with local anesthesia and no tourniquet (walant technique). The Lalonde and Tang guidelines has been respected: vent of the pulley 1,5 to 2 cm proximaly, solid six strand suture with no gap after several active motion, authorization to move it but not to use it, and education of the patient who see the finger at the end of the procedure. Immediate rehabilitation started few days after surgery.
Results and Conclusions: The ultrasonography was possible for every patient. The Doppler mode was not a good exam to attest if the vascularization was correct around the injuried tendon.
The walant anesthesia has been performed successfully for all the patients (no sedative drugs or general anesthesia needed). The tendon was repaired with the respect of a part of A2 pulley. The opening of the A4 pulley was done for 3 patients. At one and a half month follow-up, there was no rupture observed. The mean total active motion (TAM) in flexion (MP+PIP+DIP) was 190° and the mean TAM in extension was 5° of flessum.
A late FDP tendon repair has been performed successfully for this short cohort. We recommend to use ultrasonography to check the retracted FDP tendon and to use the walant technique respecting the Lalonde and Tang guidelines to check the suture.
