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Flexor tendon repair

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https://www.readbyqxmd.com/read/28740775/acute-a4-pulley-reconstruction-with-a-first-extensor-compartment-onlay-graft
#1
Michael G Jakubietz, Rainer H Meffert, Karsten Schmidt, Joerg G Gruenert, Rafael G Jakubietz
BACKGROUND: The integrity of the flexor tendon pulley apparatus is crucial for unimpaired function of the digits. Although secondary reconstruction is an established procedure in multi-pulley injuries, acute reconstruction of isolated, closed pulley ruptures is a rare occurrence. There are 3 factors influencing the functional outcome of a reconstruction: gapping distance between tendon and bone (E-space), bulkiness of the reconstruction, and stability. As direct repair is rarely done, grafts are used to reinforce the pulley...
June 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28728940/silicone-infusion-tubing-instead-of-hunter-rods-for-two-stage-zone%C3%A2-2-flexor-tendon-reconstruction-in-a-resource-limited-surgical-environment
#2
K Kibadi, F Moutet
The authors describe their experience using silicone infusion tubing in place of Hunter rods for two-stage zone 2 flexor tendon reconstruction in a resource-limited surgical environment. This case report features a 47-year-old, right-handed man who had no active PIP and DIP joint flexion in four fingers of the right hand 5 months after an injury. During the first repair stage, the A2 and A4 pulleys were reconstructed using an extensor retinaculum graft. An infusion tube was inserted instead of Hunter rods...
July 17, 2017: Hand Surgery and Rehabilitation
https://www.readbyqxmd.com/read/28718311/a-biomechanical-study-of-a-novel-asymmetric-6-strand-flexor-tendon-repair-using-porcine-tendons
#3
Yoke Rung Wong, Shian Chao Tay
BACKGROUND: This study evaluated the biomechanical performance of a novel asymmetric 6-strand flexor tendon repair technique without locking loops. METHODS: Twenty porcine flexor tendons were equally repaired by using the asymmetric technique and compared with the modified Lim-Tsai repair technique. The ultimate tensile strength, load to 1-mm gap force, stiffness, and mechanism of failure were measured. RESULTS: The asymmetric repair technique had significantly higher tensile strength (63...
January 1, 2017: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28709791/molecular-biology-of-flexor-tendon-healing-in-relation-to-reduction-of-tendon-adhesions
#4
REVIEW
Anais Legrand, Yoav Kaufman, Chao Long, Paige M Fox
Tendon injuries are encountered after major and minor hand trauma. Despite meticulous repair technique, adhesion formation can occur, limiting recovery. Although a great deal of progress has been made toward understanding the mechanism of tendon healing and adhesions, clinically applicable solutions to prevent adhesions remain elusive. The goal of this paper is to review the most recent literature relating to the tendon healing and adhesion prevention.
July 11, 2017: Journal of Hand Surgery
https://www.readbyqxmd.com/read/28702884/decellularization-of-large-tendon-specimens-combination-of-manually-performed-freeze-thaw-cycles-and-detergent-treatment
#5
Susanne Pauline Roth, Ina Erbe, Janina Burk
Reliable decellularization techniques applicable to tendon tissue play a critical role in the field of current tissue engineering. Particularly, an application as three-dimensional culture model for in vitro research and translational approaches to establish graft-based tendon repair as a routine clinical tool represent two main application fields for decellularized tendon scaffolds. Considering methodological issues of tendon decellularization, one of the major challenges lies in the preservation of the tendon-specific extracellular matrix (ECM) architecture to reflect natural tissue characteristic as best as possible...
July 13, 2017: Methods in Molecular Biology
https://www.readbyqxmd.com/read/28698915/surgical-treatment-of-stage-ii-posterior-tibialis-tendon-dysfunction-ten-year-clinical-and-radiographic-results
#6
Alberto Ruffilli, Francesco Traina, Sandro Giannini, Roberto Buda, Fabrizio Perna, Cesare Faldini
INTRODUCTION: Grade II chronic tibialis posterior tendon dysfunction (PTTD) poses a reconstructive challenge to the orthopaedic surgeon. Aim of this retrospective study is to report the clinical and radiographical results of a case series of 63 patients (102 ft) affected by grade II PTTD who underwent tailored surgical treatment at 10-year mean follow-up. MATERIALS AND METHODS: Sixty-three patients (102 ft) were available for clinical and radiological evaluation and were retrospectively reviewed at a mean follow-up of 125...
July 11, 2017: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/28686669/obesity-type-ii-diabetes-alters-macrophage-polarization-resulting-in-a-fibrotic-tendon-healing-response
#7
Jessica E Ackerman, Michael B Geary, Caitlin A Orner, Fatima Bawany, Alayna E Loiselle
Type II Diabetes (T2DM) dramatically impairs the tendon healing response, resulting in decreased collagen organization and mechanics relative to non-diabetic tendons. Despite this burden, there remains a paucity of information regarding the mechanisms that govern impaired healing of diabetic tendons. Mice were placed on either a high fat diet (T2DM) or low fat diet (lean) and underwent flexor tendon transection and repair surgery. Healing was assessed via mechanical testing, histology and changes in gene expression associated with collagen synthesis, matrix remodeling, and macrophage polarization...
2017: PloS One
https://www.readbyqxmd.com/read/28673623/primary-flexor-tendon-repair-with-early-active-motion-experience-in-europe
#8
REVIEW
Thomas Giesen, Maurizio Calcagni, David Elliot
The protocol for primary flexor tendon repair in zones 1 and 2 of the hand is changing. This article discusses recent changes. Immediate repair within 48 hours is performed whenever possible. A 6-strand core suture is performed using the M modification of Tang's technique. The pulleys are divided to allow free excursion of the repaired tendon within the tendon sheath. To avoid repaired structures within the sheath being too bulky, the authors generally repair only half of the flexor digitorum superficialis...
August 2017: Hand Clinics
https://www.readbyqxmd.com/read/28673622/strong-digital-flexor-tendon-repair-extension-flexion-test-and-early-active-flexion-experience-in-300-tendons
#9
REVIEW
Jin Bo Tang, Xiang Zhou, Zhang Jun Pan, Jun Qing, Ke Tong Gong, Jing Chen
Over the past 2 decades, repair and rehabilitation methods of primary repair of the digital flexor tendon have changed. In this article, we outline interim results from ongoing investigations in several units. Surgeons in these units now perform digital flexor tendon repairs according to a treatment protocol. Before adopting the protocol, they had no history of tendon-related research; they had not used any of the repair and rehabilitation methods described in the protocol. The surgeons involved are junior or midlevel attending surgeons...
August 2017: Hand Clinics
https://www.readbyqxmd.com/read/28671883/prevention-of-peritendinous-adhesion-formation-after-the-flexor-tendon-surgery-in-rabbits-a-comparative-study-between-use-of-local-interferon-%C3%AE-interferon-%C3%AE-and-5-fluorouracil
#10
Mohammad Javad Fatemi, Shahram Shirani, Roohollah Sobhani, Amir Hossein Lebaschi, Mohammad Javad Gharegozlou, Tooran Bagheri, Mirsepehr Pedram, Mohsen Saberi, Shirin Araghi, Mohammad Ali Fatemi
BACKGROUND: Peritendinous adhesion is the most common complication after tendon surgery, particularly in zone II of the hand. Prevention of inflammation around the tendon, which develops after trauma and surgery, can decrease the tendon adhesion formation. This study compares the effect of some anti-inflammatory cytokines with 5-fluorouracil (5-FU) on the tensile strength and in prevention of peritendinous adhesion formation. METHODS: Sixteen rabbits were allocated equally into 4 groups...
June 1, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28654614/evidence-based-medicine-surgical-management-of-flexor-tendon-lacerations
#11
Robin N Kamal, Jeffrey Yao
LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Accurately diagnose a flexor tendon injury. 2. Develop a surgical approach with regard to timing, tendon repair technique, and rehabilitation protocol. 3. List the potential complications following tendon repair. SUMMARY: Flexor tendon lacerations are complex injuries that require a thorough history and physical examination for accurate diagnosis and management. Knowledge of operative approaches and potential concomitant injuries allows the surgeon to be prepared for various findings during exploration...
July 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28614277/the-pull-out-k-wire-anchorage-the-shepherd-s-crook-technique
#12
Daniele De Spirito, Dario Giunchi
Traditional pull-out techniques for tendon and ligament repair are still widely used in hand surgery, despite constant refinements and the development of other methods of fixation. We propose a modification of the classic technique which utilizes a K-wire as an external strut instead of the classic button. This fixation system can be usefully applied in the fixation of extensor and flexor tendons and reinsertions. It is particularly applicable in situations where a transarticular K-wire is to be used anyway, in situations of temporary joint immobilization and in other situations...
June 13, 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28610452/outcomes-of-flexor-tendon-repairs-in-zone-2-subzones-with-early-active-mobilization
#13
K Moriya, T Yoshizu, N Tsubokawa, H Narisawa, S Matsuzawa, Y Maki
We report on the outcomes of flexor tendon repair in zone 2 subzones with early active mobilization in 102 fingers in 88 consecutive patients. There were 28, 53, 15, and six fingers with repairs in zones 2A to 2D, respectively. Rupture of the repair occurred in four fingers, all in zone 2B. Excluding those with repair ruptures, the mean total active motion was 230° (range 143°-286°). Evaluated with Tang's criteria, the outcomes were ranked excellent in 39 fingers, good in 46, fair in ten, poor in three, and failure in four...
June 1, 2017: Journal of Hand Surgery, European Volume
https://www.readbyqxmd.com/read/28604156/outcomes-of-repair-of-the-lacerated-a2-pulley-with-extensor-retinaculum-during-primary-flexor-tendon-repair
#14
A El-Shebly, M El Fahar, H Mohammed, A Bahaa Eldin
We report outcomes of repairing the lacerated A2 pulley with extensor retinaculum graft in ten patients (ten fingers) during primary flexor tendon repair in zone 2. Complete A2 pulley lacerations were found in eight fingers and partial A2 pulley laceration in two. We extended the laceration in the sheath to the middle of the A4 or A1 pulley to allow tendon repair with a four-strand core suture. The A2 pulley was reconstructed with an extensor retinaculum graft. All patients followed the early controlled active mobilization protocol and recovered active range of motion at the interphalangeal joints without major extension deficits...
June 1, 2017: Journal of Hand Surgery, European Volume
https://www.readbyqxmd.com/read/28583184/effect-of-single-intralesional-treatment-of-surgically-induced-equine-superficial-digital-flexor-tendon-core-lesions-with-adipose-derived-mesenchymal-stromal-cells-a-controlled-experimental-trial
#15
Florian Geburek, Florian Roggel, Hans T M van Schie, Andreas Beineke, Roberto Estrada, Kathrin Weber, Maren Hellige, Karl Rohn, Michael Jagodzinski, Bastian Welke, Christof Hurschler, Sabine Conrad, Thomas Skutella, Chris van de Lest, René van Weeren, Peter M Stadler
BACKGROUND: Adipose tissue is a promising source of mesenchymal stromal cells (MSCs) for the treatment of tendon disease. The goal of this study was to assess the effect of a single intralesional implantation of adipose tissue-derived mesenchymal stromal cells (AT-MSCs) on artificial lesions in equine superficial digital flexor tendons (SDFTs). METHODS: During this randomized, controlled, blinded experimental study, either autologous cultured AT-MSCs suspended in autologous inactivated serum (AT-MSC-serum) or autologous inactivated serum (serum) were injected intralesionally 2 weeks after surgical creation of centrally located SDFT lesions in both forelimbs of nine horses...
June 5, 2017: Stem Cell Research & Therapy
https://www.readbyqxmd.com/read/28552932/biomechanical-properties-of-alternative-suture-technique-for-flexor-tendon-repair
#16
Tomasz Andrzejewski, Piotr Czarnecki, Mikołaj Dąbrowski, Robert Spławski, Piotr Rogala, Leszek Romanowski
PURPOSE: Flexor injuries are most common in the hand and require special attention and experience from the surgeon. Both quality and technique affect the stability of the suture. The selection of the optimum method will influence the process of rehabilitation. The aim of this study was to compare three different suture techniques based on the strength, depending on the method of breakage, i.e., axial or pulley load. METHODS: The study was divided into six sessions...
2017: Acta of Bioengineering and Biomechanics
https://www.readbyqxmd.com/read/28506172/the-effect-of-myostatin-gdf-8-on-proliferation-and-tenocyte-differentiation-of-rat-bone-marrow-derived-mesenchymal-stem-cells
#17
Wei Le, Jeffrey Yao
BACKGROUND: The future in flexor tendon surgery involves tissue engineering approaches directed toward increasing early repair strength to accelerate tendon healing and to allow for earlier onset of rehabilitation. Previous work has shown that pluripotential mesenchymal stem cells may be successfully delivered to a tendon repair site using a suture carrier. The current work describes the use of Myostatin (GDF-8) to help guide these delivered pluripotential stem cells to differentiate down a tenocyte lineage to potentially maximize the reparative effects of these cells at the tendon repair site...
June 2017: Journal of Hand Surgery Asian-Pacific Volume
https://www.readbyqxmd.com/read/28506161/symmetric-peripheral-running-sutures-are-superior-to-asymmetric-peripheral-running-sutures-for-increasing-the-tendon-strength-in-flexor-tendon-repair
#18
N Takeuchi, T Okada, N Kozono, T Shimoto, H Higaki, Y Iwamoto
BACKGROUND: The fatigue strength of three peripheral suture techniques for flexor tendon repair was compared by cyclic loading of the repairs in the porcine flexor digitorum tendon. METHODS: Thirty-six tendons were sutured using only peripheral sutures with 6-0 Nylon. An initial cyclic load of 10 N for 500 cycles was applied and increased by 10 N for an additional 500 cycles at each new load until rupture. RESULTS: The fatigue strength of the symmetric running peripheral suture was 85...
June 2017: Journal of Hand Surgery Asian-Pacific Volume
https://www.readbyqxmd.com/read/28501463/home-based-rehabilitation-in-the-postoperative-treatment-of-flexor-tendon-repair
#19
M Sanmartín-Fernández, B Fernández-Bran, J Couceiro-Otero
OBJECTIVE: To evaluate the results and complications of flexor tendon repair in which a home-based rehabilitation program was utilized without the assistance of a hand therapist during the first 4postoperative weeks. MATERIAL Y METHODS: Between July 2009 and July 2014, a total of 21 digits in 15 patients were treated in our institution for complete laceration of the flexor tendons within the flexor pulley system (zone 1 and 2). Passive and active exercises performed by the patients themselves were started the morning after the operation...
May 10, 2017: Revista Española de Cirugía Ortopédica y Traumatología
https://www.readbyqxmd.com/read/28501340/epitendinous-first-repair-of-zone-ii-flexor-digitorum-profundus-results-in-decreased-gliding-resistance
#20
Michael G Galvez, Garet C Comer, Arhana Chattopadhyay, Chao Long, Anthony W Behn, James Chang
PURPOSE: The importance of flexor tendon repair with both core and epitendinous suture placement has been well established. The objective of this study was to determine whether suture placement order affects gliding resistance and bunching in flexor digitorum profundus tendons in a human ex vivo model. METHODS: The flexor digitorum profundus tendons of the index, middle, ring, and little fingers of paired cadaver forearms were tested intact for excursion and mean gliding resistance in flexion and extension across the A2 pulley...
May 11, 2017: Journal of Hand Surgery
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