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Liczba wyników
2008 | 80 | 12 | 645-652
Tytuł artykułu

Early Results of Flexor Tendon Repair in Zone II With Modified, Four-Strand Strickland Technique

Treść / Zawartość
Warianty tytułu
Języki publikacji
EN
Abstrakty
EN
New materials, techniques of tendon suture and methods of post-operative rehabilitation offer surgeons perspective of effective repair and excellent outcomes. Results of experimental studies show that multistrand tendon suture provides better mechanical properties than two-strand technique, however, clinical use in only 4 studies did not confirm its definitive superiority to traditional method of the repair.The aim of the study was the assessment of the outcomes of the treatment of flexor tendon repair by a modified, four-strand Stickland technique.Material and methods. Flexor tendons lacerations in 60 patients, all in Verdan's zone II, without associated bone fractures and impaired blood supply were repaired by a modified, four-strand Stickland technique. An active flexion and extension of the fingers in the range restricted by a splint was recommended immediately after operation. Early results were evaluated in 51 patients, 41 men and 10 women, in a mean age of 31 years, in whom 69 tendons were repaired in 69 digits. Follow-up at 2 and 6 weeks included examination of total active range of motion (AROM) of involved fingers, rupture rate and complications.Results. Failure of the repair occurred in 3 cases (6%), including one thumb, index and little finger, all between 2nd and 6th week after the operation. A mean AROM at 2 and 6 weeks was 38% and 58% of the normal value (270° for the finger and for 170° the thumb), respectively. In 13 digits (28%) AROM at 6 weeks was excellent, greater than 80%, but in 5 digits was poor, less than 20% of the normal value. The main cause of reduced AROM was incomplete extension of the digits, due to splint employment up to 6 weeks post-operatively.Conclusions. Early results obtained in the study fail to confirm greater endurance of four-strand repair over two-strand, what suggest rupture rate closed to given in the literature. An active range of motion achieved in the group was poorer than obtained after two-strand repair in other studies, but one can expect its improvement in the longer perspective.
Słowa kluczowe
Rocznik
Tom
80
Numer
12
Strony
645-652
Opis fizyczny
Daty
wydano
2008-12-01
online
2010-05-04
Twórcy
  • Department of General and Hand Surgery, Pomeranian Medical University in Szczecin
  • Department of General and Hand Surgery, Pomeranian Medical University in Szczecin
  • Department of General and Hand Surgery, Pomeranian Medical University in Szczecin
Bibliografia
  • Tsuge K, Ikuta I, Matsuishi Y: Repair of flexor tendons by intratendinous tendon suture. J Hand Surg 1977; 2: 436-40.
  • Savage R: In vitro studies of a new method of flexor tendon repair. J Hand Surg 1985; 10: 135-41.
  • Tang JB: Flexor tendon repair in zone 2C. J Hand Surg 1994; 19: 72-75.
  • Savage R, Risitano G: Flexor tendon repair using a „six-strand” method of repair and early active immobilisation. J Hand Surg 1989; 14: 396-99.
  • Elliot D: Primary flexor tendon repair - operative repair, pulley management and rehabilitation. J Hand Surg 2002; 27B: 507-13.
  • Xie RG, Zhang S, Tang JB et al.: Biomechnical studies of 3 different six-strand flexor tendon repair techniques. J Hand Surg 2002; 27A: 621-27.
  • Cao Y, Tang B: Biomechanical evaluation of a four-strand modification of the Tang method of tendon repair. J Hand Surg 2005; 30B: 374-78.
  • Lawrence TM, Davis TR: A biomechanical analysis of suture materials and their influence on four-strand flexor tendon repair. J Hand Surg 2005; 30A: 836-41.
  • Angeles JG, Heminger H, Mass DP: Comparative biomechanical performances of 4-strand core suture repairs for zone II flexor tendon lacerations. J Hand Surg 2002; 27A: 508-17.
  • Gill RS, Lim BH, Shatford RA et al.: A comparative analysis of the six-strand double-loop flexor tendon repair and three other techniques: a human cadaveric study. J Hand Surg 1999; 24A: 1315-22.
  • Tang JB, Gu YT, Rice K et al.: Evaluation of four methods of flexor tendon repair for postoperative active rehabilitation. Plast Reconstr Surg 2001; 742-49.
  • Powell ES, Trail IA: Forces transmitted along human flexor tendons during passive and active movements of the fingers. J Hand Surg 2004; 29B: 386-89.
  • Xie RG, Xue HG, Gu HJ et al.: Effects of locking area on strength of 2 and 4-strand locking tendon repairs. J Hand Surg 2005; 30A: 455-60.
  • Amadio PC: Friction of the gliding surface. Implications for tendon surgery and rehabilitation. J Hand Ther 2005; 18: 112-19.
  • Small JO, Brennen MD, Colville J: Early active mobilization following flexor tendon repair in zone 2. J Hand Surg 1989; 14B: 383-91.
  • Elliot D, Moiemen NS, Flemming AS et al.: The rupture rate of acute flexor tendon repairs mobilized by the controlled active motion regimen. J Hand Surg 1994; 19B: 607-12.
  • Strickland JW: Development of flexor tendon surgery: twenty-five years of progress. J Hand Surg 2000; 25A: 215-35.
  • Peck FH, Bucher CA, Watson JS et al.: A comparative study of two methods of controlled mobilization of flexor tendon repairs in zone 2. J Hand Surg 1998; 23B: 41-45.
  • Yii NW, Urban M, Elliot D: A prospective study of flexor tendon repair in zone 5. J Hand Surg 1998; 23B: 642-48.
  • Zyluk A: Metody usprawniania palców ręki po operacyjnym leczeniu uszkodzeń ścięgien zginaczy w strefie I i II. Chir Narz Ruchu Ortop Pol 1999; 64: 327-33.
  • Caulfield RH, Maleki-Tabrizi A, Patel H et al.: Comparison of zones 1 to 4 flexor tendons repair using absorbable and unabsorbable four-strand core sutures. J Hand Surg 2008: 33E: 412-17.[WoS][Crossref]
  • Hoffmann GL, Buchler U, Vogelin E: Clinical results of flexor tendon repair in zone II using a six-strand double-loop technique, compared with a two-strand technique. J Hand Surg 2008: 33E: 418-23.[WoS]
  • Chow JA, Thomes LJ, Dovelle S et al.: A combined regimen of controlled motion following flexor tendon repair in "no man's land". Plast Reconstr Surg 1987; 79: 447-53.[Crossref]
  • Saldana MJ, Chow JA, Gerbino P et al.: Further experience in rehabilitation of zone II flexor tendon repair with dynamic traction splinting. Plast Reconstr Surg 1991; 87: 543-46.[Crossref]
  • Strickland JW, Glogovac SV: Digital function following flexor tendon repair in zone II. A comparison of immobilization and controlled passive motion techniques. J Hand Surg 1980; 5: 537-43.
Typ dokumentu
Bibliografia
Identyfikatory
Identyfikator YADDA
bwmeta1.element.-psjd-doi-10_2478_v10035-008-0100-8
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