Article
Contribution of the integrity of the vincula tendinum in the delay of the repair of the flexor digitorum profundus tendon in zone II
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Authors
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Laura Velasco-González
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Marta Almenara-Fernández
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Gonzalo Pérez-López
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Alex Grau-Blanes
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Claudia Lamas-Gómez
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| Published: | February 6, 2020 |
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Outline
Text
Objectives/Interrogation: Isolated laceration of the flexor digitorum profundus (FDP) tendon appears when the section is in zone I or and sometimes in zone II. In some cases, due to a delayed diagnosis or to a fail of the primary suture, the reparation is performed some weeks after the injury. In most of these cases, the intact vincular system prevents the retraction of the FDP tendon and this can be repaired as would be done in a primary repair. Finger in which the vincular system was not disrupted had greater final total active motion than had those without intact vincula. The objective of the study was to explain our experience and outcomes in the delayed treatment of the lacerations of the FDP tendon without tendon retraction due to the presence of the intact vincular system.
Methods: Between 2005 and 2016, 8 patients were operated with delay reparation of the FDP tendon without retraction of the same in zone II. The injury was diagnosed clinically and with MRI. The injury was localized in the proximal interphalangeal (PIP) joint in 5 cases and in middle phalanx in the other 3.
Surgery treatment and outcomes were analysed. Visual analog scale (VAS) scale, range of motion and Disabilities of the Arm, Shoulder and Hand(QuickDASH) score were evaluated at the final of the follow-up.
Results and Conclusions: There were eight patients with FDP tendon lacerations. There were 5 men and 3women with a mean age of 27 years old. Reparation was performed after 3.3 weeks (3-5). The initial injury was located in zone II in all the cases. The lacerations were in the index finger in two cases, long finger in 2, little finger in 3 and in ring finger in one case. Minimun follow-up was 12 months.
The intraoperative findings found the intact VLP (vinculum longum profundus) in all cases that avoided the proximal retraction of the FDP. A modified Kessler suture was performed in all cases. All patients had good functionality measured with the Quick-DASH score at the final of the follow-up.
The integrity of the VLP could be one reason of the lack of retraction that occurs sometimes in FDP tendon injuries. When it occurs and the diagnosis is delayed, tendon suture can be performed like an acute primary repair. In cases of intact VLP, the vincular blood supply in combination with the synovial fluid nutrition maintain tendon viability and permits tendon healing after tendon repair.
