Article
Suture Technique with strain relief for repair of flexor tendons of the zone II of the hand
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Authors
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Luis Antonio Buendia
- Hospital Samaritano São Paulo, Hospital Municipal Tatuapé São Paulo, Sao Paulo, Brazil
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Heitor José Rizardo Ulson
- Hospital Samaritano São Paulo, Sao Paulo, Brazil
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: To assess the joint mobility of patients submitted to primary repair surgery of the flexor tendon injuries of the hand with the modified Kessler-Kleinert technique associated with a dynamic anchorage pull out suture, for relieving the tension at the Kessler-Kleinert suture.
Methods: Eight patients from eleven fingers with injuries occurred within maximum 5 days with short-incised or short-blunt cuts referred from the Emergency Room of the institution. All patients received were informed consent and clarified prior to surgical procedure, and performed under WALANT anesthesia.
The surgical technique was based on the Kessler-Kleinert type tenorrhaphy with 4-0 mononylon core plus epitendon running suture with 6-0 mononylon. At the end a double-loop was added with 3-0 nylon monofilament running parallel to this tendon inside the tendon sheath, anchoring proximally and distally to the initial terminal-terminal repair. With this technique we obtaned a reinforcement of the tendon ends: thus protecting the suture site. The dressing and placement of an orthosis or plaster splint were applied, the immobilization was removed and the patient was referred to the occupation therapy service, where they were encouraged to use both: actively and passively operated finger
Results and Conclusions: The results of the passive and active measurment of the range of motion (TAM) at the MTF, IFP and IFD joints of the affected fingers during the period of postoperative follow-up at the different occasion showed a considerable gain with statistical significance p<1. The Multiple Comparisons analysis of Bonferroni and the ANOVA method were used. The Disabilities of the Arm, Shoulder and Hand (DASH) Score showed a Satisfaction Level of 8.75. According to Strickland's criteria we had 8-fingers (72,27%) excellent results, 2-fingers (18,18 %) good results and 1-finger (0,9%) regular results. All patients were evaluated in the first week after the surgical procedure, after the third week, at 3 months and 6 months of post operative follow up.
This considerable gain in amplitude in the early phases of the postoperative recovery may be related to the immobilization release, achieved early due to the anchorage suture technique which allowed early active motion.
No infection, pull out suture failure occurred.
