Article
Modified Brunelli technique for flexor tendons repair in zone II
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Authors
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Alexandru Valentin Georgescu
- University of Medicine Iuliu Hatieganu Cluj Napoca, Clinical Hospital of Recovery, Cluj Napoca, Romania
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Ileana Matei
- University of Medicine Iuliu Hatieganu Cluj Napoca, Clinical Hospital of Recovery, Cluj Napoca, Romania
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Irina Capota
- University of Medicine Iuliu Hatieganu Cluj Napoca, Clinical Hospital of Recovery, Cluj Napoca, Romania
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Octavian Olariu
- Clinical Hospital of Recovery, Cluj Napoca, Romania
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: The repair of flexor tendon lesions in Zone II remains one of the most challenging problems in hand surgery. The functional outcome depends to both a very accurate surgery and a very intensive hand therapy. We will present our experience by using a modified Brunelli technique, which moves the tension from the suture site distally, what allows the very early beginning of hand therapy and improve the quality of functional results.
Methods: Our method consists in using a two-strand suture repair by passing a 2/0 stitch through the tendon from its insertion to the proximal stump, and then back to the fingertip were is knotted in a tie-over fashion. A running 4/0 suture at the disruption level completes the procedure. This procedure allows the beginning of passive movements in the first postoperative day, the active movements in the second day, and movements against resistance after 3-4 days. We used this procedure in 156 patients, 115 men and 67 female aged between 6 and 75 years. One flexor tendon was disrupted in 139 patients, two in 11, three in 3, and four in three. Both the profundus and sublimis tendons were interested in 101 patients. Digital nerves disruption was found in 113 patients, and a skin defect in 23 patients.
Results and Conclusions: The average follow-up was 14 months. All patients continued to have the samesocial life and were able to work in the same place. No problem on the finger pulp related to the tie-over suturewas recorded. We had only one rupture. According with the scoring system proposed by Strickland, our results can be judged as excellent in all the cases (regain of 75-100% of normal activemovement). According with the scoring system proposed by Lister, the results can be judged as good (regain of flexion to within less than 3 cm of the distal palmar crease) in 30% of cases, and as very good (regain of flexion to within 1cm of the distal palmar crease and an extension deficit less than 15 degrees) in 70% of cases.
Moving the tension from the repair site tothe finger pulp allows the very early beginning of the activemobilization against resistance. This contributes to a very good modeling of the tendon, minimal adhesion formation, and avoids the joints stiffness and the extension deficit of the interphalangeal joints.
