A Post-Operative Regime after Digital Flexor Tenolysis

Abstract

Tenolysis of the flexor tendons was performed in 78 fingers (72 patients) by the same surgeon. Two technical modifications were introduced: reconstruction of a robust pulley; and initial immobilization with the tendon in a proximally migrated position, permitting later breakdown of early adhesions by gentle extension either by the surgeon or using an extension spring. After a mean follow-up of 21.5 months, the total active movement was improved from 135 degrees (pre-operative) to 203 degrees (post-operative) in 84% of fingers and from 65 degrees to 115 degrees in 78% of thumbs. This corresponds to a reduction in impairment of 10.1% for the thumb and 21.6% for the fingers. There was no improvement in four digits and nine cases were made worse, averaging a loss of range of 25.4 degrees. Among these were two cases of skin breakdown and two cases of tendon rupture (2.5%), one combined with skin necrosis.

Flexor Tenolysis

“…Both flexors are raised en block [5], and in a precise and methodic fashion tendon adhesions are lysed. Next, when possible, the flexor digitorum profundus and flexor digitorum superficialis tendons should be separated from one another [4].…”

“…Next, when possible, the flexor digitorum profundus and flexor digitorum superficialis tendons should be separated from one another [4]. The tendon can be trimmed slightly and previous suture and foreign material debrided [5]. Because of severe adhesions and dense scar it may be necessary to sacrifice the flexor digitorum superficialis [8] to allow for unrestricted tendon gliding through pulley systems.…”

“…Dissection proceeds from the unaffected area to the affected area [5] and the borders of the flexor tendons are defined [12]. Both flexors are raised en block [5], and in a precise and methodic fashion tendon adhesions are lysed.…”

“…The concept of surgical tendon liberation from post-traumatic cicatrix has been in existence for more than 60 years [3]. Although the efficacy of tenolysis originally was questioned [4], it is now considered a procedure with valuable clinical usefulness in the restitution and enhancement of digital function [4][5][6][7][8].…”

Biodegradable Films in Trauma and Orthopedic Surgery

“…In orthopedic and traumatological surgical procedures, adhesions and resulting scar tissue formation causes significant postoperative problems [10,11]. This often hinders successful rehabilitation.…”