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Flexor tendon repair

There is one flexor tendon to the thumb and two flexor tendons to each of the fingers. One of those tendons bends the end joint (distal interphalangeal joint) and the other tendon flexes the second joint in the digit (proximal interphalangeal joint.). If a flexor tendon to a digit is cut when the hand is at rest the finger will tend to point out straighter than the other fingers. This is called a loss of a normal "cascade of the fingers". It will also involve an inability to roll the finger up. Flexor tendon injury is a serious injury and most cases need exploration and repair by a Hand Surgeon.

ANAESTHETIC

General or regional anaesthetic.

OPERATIVE PROCEDURE

Incision - the cut has caused the tendon to be severed is normally extended, coming down towards the palm and away from the finger which enables a good visualisation of the cut tendon so that the tendon can be repaired. It is quite common, particularly if the cut has occurred with a clenched fist (i.e. grabbing onto a knife) that the tendon is in tension and the ends ping apart, thus further incisions may be necessary down to the finger towards the palm in order to retrieve one tendon end. The tendon ends are then brought together and they are sutured with a braided nylon suture, what is called a core suture, and the ends are sewn over and over with a fine nylon suture in order to reduce any snagging that a repair may cause.

The wound is then closed with nylon sutures and a flexor tendon splint applied. Normally this has the wrist with about 30ยบ of forward bend (flexion) and the fingers also flexed. The plaster looks a little bit like a head of a cobra snake.

POST OPERATIVELY

The patient is admitted over night and given intravenous antibiotics. The next morning the dressing is taken down, a new thermoplastic splint is applied and physiotherapy exercises are started. IT IS IMPORTANT THAT THE PATIENT DOS NOT ACTIVELY BEND THE FINGER STRAIGHT AWAY POST OPERATIVELY. The physiotherapist will let you know when this is feasible. This normally happens at about two weeks. However, passive bending of the finger using the other hand to push it down into the palm is allowed straight away. You are allowed to actively straighten the finger up to the splint.

COMPLICATIONS

  1. The repair can rupture. The classic time for this repair to rupture is between ten and fourteen days post operatively. This probably occurs in 2% to 3% of cases.
  2. Infection. This generally will have been introduced at the time of the injury. Antibiotics are given as a prophylatic measure. However, if the repair gets infected this can certainly lead to rupture of the repair.
  3. Post operative stiffness. It is very common after flexor tendon injuries for stiffness to occur. It is uncommon to get a full and complete range of movement as a result of the repair. There is generally some deficit in range of movement after the repair.
  4. A bad reaction to surgery (RDS or algodystrophy)