Pathomechanics and Management of Secondary Complications Associated with Tendon Adhesions Following Flexor Tendon Repair in Zone II

Chinchalkar, Shrikant J.; Larocerie-Salgado, Juliana; Suh, Nina

doi:10.1055/s-0036-1586173

Cited by 7 publications

(7 citation statements)

References 54 publications

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“…Misdiagnosis, in turn, will delay the management and increase the risk of major complications [ 17 ]. If left untreated, flexor tendon repair in zone II can lead to a secondary complication resulting in fixed deformities and decreased function [ 6 ]. Animal models suggest that the earlier flexor tendons are repaired, the better the patient's functional outcome [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Complications following flexor tendon repair are categorized into early and late stages. Early complications include hematoma, infection, dehiscence, tendon or pulley rupture, and the tendon's triggering in the sheath [ 6 ]. Late complications include tendon adhesions, rupture after mobilization, flexion contracture, lumbrical plus deformity, and bowstringing [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…This is because the palmar aspect of the flexor tendon has an inadequate blood supply compared to the dorsal one, which affects tendon healing [ 9 ]. The fibrous-osseous pulley system also contributes to the poorer prognosis of flexor tendon injuries since injuries to the fibrous-osseous sheath will result in profound adhesions affecting the tendon function [ 6 ]. Moreover, concomitant nerve and vessel injuries are common due to their anatomical proximity [ 3 ], which can affect wound healing and result in poor outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Isolated Flexor Digitorum Profundus Injuries in Flexor Zone II of the Hand: A Report of Five Cases

Alkandari¹,

Alawadhi²,

Alawadhi³

et al. 2023

Cureus

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Injuries of the hand's flexor tendons carry a poor prognosis, mainly if they are in zone II (also called 'the critical zone' or 'no man's land'). The superficial tendon in this zone ends by bifurcating and attaching to the sides of the middle phalanx, exposing the deep tendon that attaches to the distal phalanx. Thus, trauma to this zone may result in a complete cut to the deep tendon while the superficial one remains intact. The lacerated tendon, in turn, would be retracted proximally to the palm making it difficult to be found during wound exploration. The complex anatomy of the hand, particularly that of the flexor zones, may contribute to the misdiagnosis of a tendon injury. We report five cases of an isolated cut of the flexor digitorum profundus (FDP) tendon after traumatic injury to the flexor zone II of the hand. The mechanism of injury of each case is reported together with a clinical approach that guides ED physicians toward diagnosing flexor tendon injuries in hand. In cut wounds involving the flexor zone II of the hand, it should be not surprising to find that the deep tendon (FDP) is completely lacerated without an injury to the superficial one (FDS). Therefore, we conclude that a systematic examination approach for traumatic hand injuries is essential to ensure the proper assessment. Understanding the mechanism of injury, performing a systemic examination approach, and having basic anatomical knowledge of flexor tendons of the hand are essential to identifying tendon injuries, anticipating complications, and providing adequate healthcare.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Isolated Flexor Digitorum Profundus Injuries in Flexor Zone II of the Hand: A Report of Five Cases

Alkandari¹,

Alawadhi²,

Alawadhi³

et al. 2023

Cureus

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“…The addition of active flexion to the modified Kleinert regime significantly improves the recovery of the original function of the digital flexor tendon, increases grip strength, and accelerates recovery with better results when compared to the modified Kleinert regime [ 19 ]. Early mobilization is critical as it prevents the formation of adhesions and joint stiffness [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Tendon Reconstruction With Cadaveric Allograft in a Patient With Flexor Tendon Injury Without Treatment for Six Months

Lizarzaburu-Ortiz

Dominguez

Valdez

et al. 2021

Cureus

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We present the case of an 18-year-old male patient with a penetrating lesion at zone II of the flexor compartment of the left hand. During surgery, complete reabsorption of the second deep and superficial flexor tendons was evidenced, prompting the decision to perform a two-stage procedure. First, a spacer was placed, and pulley reconstruction was performed. Six weeks later, we placed a cadaveric allograft and splint with the Kleinert-Duran technique for proper rehabilitation. Our case report highlights that a two-stage procedure with an allograft is a feasible technique resulting in good post-surgical functional status despite tendon reabsorption and six months between trauma and surgical intervention.

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“…The outcomes of zone 2 tendon repairs are likely less satisfactory when the injuries are more severe (such as with fractures or with extensive avulsion of skin and soft tissue). More optimized rehabilitation protocols may reduce the density of adhesion formation, which is caused by inadequate differential tendon motion between FDS and FDP during the initial healing phase (Chinchalkar et al., 2016). Combining synergistic wrist motion and active mid-range digit flexion could improve the differential tendon excursion without overloading the healing tendons (Chinchalkar et al., 2016).…”

Section: Site-specific Complicationsmentioning

confidence: 99%

Complications of flexor tendon repair

Chen,

Tang

2024

J Hand Surg Eur Vol

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This article reviews and highlights complications of flexor tendon repairs. Although the outcomes of flexor tendon repairs have improved over the years, fair or poor functional outcomes are seen, especially in patients whose trauma involves multiple structures of the hand and in zone 5 with multiple tendon lacerations. Rupture of the flexor tendon after repair is no longer a major problem if current repair principles are carefully adhered to. Different degrees of adhesion formations and interphalangeal (IP) joint stiffness still occur in a few patients. Early active postoperative mobilization and use of a shorter splint with sparing of the wrist are effective measures to prevent adhesion formation and IP joint stiffness. Given the overall poor results and high rate of complications with flexor digitorum profundus (FDP) repairs in zone 1, a direct repair of the FDP tendon to any short remnant of the distal insertion with 10-strand or even stronger core suture repair is adopted by many units.

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Pathomechanics and Management of Secondary Complications Associated with Tendon Adhesions Following Flexor Tendon Repair in Zone II

Cited by 7 publications

References 54 publications

Isolated Flexor Digitorum Profundus Injuries in Flexor Zone II of the Hand: A Report of Five Cases

Isolated Flexor Digitorum Profundus Injuries in Flexor Zone II of the Hand: A Report of Five Cases

Tendon Reconstruction With Cadaveric Allograft in a Patient With Flexor Tendon Injury Without Treatment for Six Months

Complications of flexor tendon repair

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