Techniques for Retrieval of Lacerated Flexor Tendons: A Scoping Review

Abstract

Introduction: Flexor tendon laceration is often followed by retraction of the proximal stump. The goals of this review were to describe the myriad of proximal stump retrieval surgical techniques and where available to provide the clinical evidence associated with each. Methods: A Medline and Web of Science search was performed to identify any publication whose primary purpose was to describe a tendon retrieval technique. The techniques were assigned to 8 groups. Clinical outcomes, where reported, and advantages and disadvantages of the technique as reported by the authors of the articles were analyzed. Results: Eight-hundred and forty-one publications complied with the search terms, and 33 articles were included in the current analysis. Only 2 of these articles were randomized controlled trials, and they were of low quality. Conclusion: There is no high-quality evidence to allow quantitative comparison of tendon retrieval techniques. An incremental approach can be recommended based on the qualitative review. After failed atraumatic attempts to retrieve the tendon by milking, retrieval should be done through proximal incision at the A1 pulley level, preferably without pulling the tendon out of the wound. When available, using an endoscope to retrieve the tendon appears to be a promising alternative.

Current clinical opinion on surgical approaches and rehabilitation of hand flexor tendon injury—a questionnaire study

“…In zone II flexor tendon injury, retrieval of retracted proximal tendon stump can be problematic due to the presence of the relatively inelastic tendon sheath; trauma created during retrieval can lead to poor functional outcome and needs to be minimized. A plethora of tendon retrieval methods were published in literature ( 1 , 11 ). Agreed with the current evidence, in this study, most respondents (85%) supported atraumatic tendon retrieval, and reported a variety of retrieval techniques.…”

“…Most respondents (45%) mentioned the use of sutures and a flexible feeding tube, and some respondents (10%) also mentioned the creation of an extra incision. However, a number of the respondents (15%) still chose “Milking” in which the proximal tendon stump was milked down through the tendon sheath despite its low success rate (61%) ( 11 ). Supported by 10% of the respondents, looped sutures were able to retrieve the proximal stump through tendon sheath without the need of a feeding tube ( 34 ).…”

“…Use of endoscope and other minimally invasive surgical instrument has been described in the literature for the retrieval of the retracted tendon stump ( 11 ) and flexor tendon repair ( 12 ). With advances in the surgical instrumentation, minimally invasive surgeries have been widely used in other tendon repair such as Achilles tendon to deliver beneficial outcome ( 13 ).…”