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TENDON SUTURE

BY :UKI



HISTORY

• Mode of injury : sharp objects or blunt

injury

• Finger position when the injury took place



PHYSICAL EXAMINATION

• LOOK :

– Position of the injured fingers!

– Location of the wound

• F""L : Pain

• MO#" : $ange of %otion



The purpose of tendon suture is :

- to approximate the ends of a tendon

- to fasten one end of a tendon to adjoining

tendons - to bone and to hold this position during

healing.

Basic Tendon Techniques



Six characteristics of an ideal tendon

repair :

(1). eas placement of sutures in the tendon

(!). secure suture "nots

(#). smooth juncture of tendon ends

($). minimal gapping at the repair site

(%). minimal interference &ith tendon'ascularit

(). sufficient strength throughout healing to

permit application of earl motion

stress to the tendon.



bsorbable sutures (catgut, Dexon, Vicryl )* become

&ea" too earl after surger to be effecti'e in tendonrepair.

Snthetic sutures and nlon maintain their resistance

to disrupting forces longer than polproplene(Prolene) and polester suture*

+olester sutures (Ticron; Mersilene) pro'ide

sufficient resistance to disrupting forces and gap

formation* handle easil* and ha'e satisfactor "not

S,T, /T0



FLEXOR TENDON



ANATOMY



TREATMENT : Zone I



TREATMENT : Zone II

• &reated with pri%ary or delayed pri%ary

repair ' – () days post injury!

• *oth of F+P and F+, repair -ersus F+P repair

only

• ".tension splinting



TREATMENT : Zone III

• &reated with pri%ary or delayed pri%ary

repair up to / weeks after injury!

• *oth of F+P and F+, should be repair



TREATMENT : Zone IV & V

• Pri%ary repair is reco%%ended

• +elayed pri%ary repair should be done

within / weeks of injury



INCISIONS



SUTURE TECHNIQUES



POSTOPERATIVE MANAGEMENT



COMPLICATIONS

• 0one 1 : fle.ion contracture at +1P 2 P1P3

tenodesis3 detach%ent

• 0one 11 – # : tendon rupture



EXTENSOR TENDON



ANATOMY



xtensor Tendon upture

- 2or a closed extensor tendon rupture from its

insertion into the distal phalanx* the treatmentusuall is nonsurgical

- The distal interphalangeal joint is constantl held in

hperextension on a splint for to 3 &ee"s and atnight onl for 1 additional &ee".



cute Transection of xtensor Tendon

- n open injur of the extensor tendon insertion

requires repair of the tendon.-xtension of the s"in laceration proximall required

to grasp the tendon and mobili4e it to its insertion* a

roll suture usuall is sufficient .

-The repair can be protected &ith a transarticular5irschner &ire.

-The roll suture is remo'ed after approximatel #

&ee"s* the 5irschner &ire is remo'ed at

approximatel $ &ee"s*

-The finger is splinted for an additional $ &ee"s to

protect the repair.

-+rogressi'e motion exercises are commenced and

continued until maximum function has been

achie'ed.



oll Stitch

The roll stitch is especially useful for suturing extensor tendons over or near the

metacarpophalangeal joints.



• Use a 4-0 monofilament wire or 4-0 monofilament nylon threaded

on a small, curved needle

• uture through the s!in just medial or lateral to the divided

tendon

• Through the proximal segment of the tendon near its margin from

superficial to deep, and then through the deep surface of the

distal segment, to emerge on its superficial surface.

• "ext, pass it proximally and through the opposite margin of the

proximal segment and #ring it out through the s!in on the

opposite side of the tendon . $e certain that the suture slides

easily in the s!in and tendon.

• %t a#out 4 wee!s the suture can #e removed #y pulling on one ofits ends.



EXTENSOR INJURIES : Zone I

• Mallet finger 4 baseball finger

• 5lassification :– &ype 1 : closed trau%a3 loss continuity3 s%all a-ulsion

fracture 678– &ype 11 : Laceration3 +1P3 loss continuity

– &ype 111 : 9brasion3 loss of skin3 subcutaneous co-er3

tendon substance

– &ype 1# :9 &ransepiphyseal plate fracture

* ;yperfle.ion injury

5 ;ypere.tension injury




• &reat%ent of type 1 Mallet Finger

– Plaster cast : +1P slight hypere.tension3 P1P <=>

fle.ion

– ,plints : < weeks continous splinting3 ' weeksnight splinting

– K wire fi.ation : across +1P joint

– ".ternal tendon suture

– +irect repair




&reat%ent of type 11 2 111 Mallet Finger




• &reat%ent of type 1# Mallet Finger

– 5ontinous splinting3 +1P e.tension for / – )

weeks

– Operati-e treat%ent : fracture frag%entsgreater than (7/ articular surface3 K wire

fi.ation3 post op splint




&reat%ent of type 1# Mallet Finger



EXTENSOR INJURIES : Zone II

• ,econdary to laceration or crush injury

• &reated by interrupted sutures followed by

static splinting



EXTENSOR INJURIES : Zone III

• *outonniere lesion

• 9cute fle.ion a-ulsion of central slip

• &reat%ent of closed *outonniere defor%ity:

– ,plinting of P1P joint

– &ransarticular K wire3 P1P joint in full e.tension



EXTENSOR INJURIES : Zone III&reat%ent of open *outonniere defor%ity



EXTENSOR INJURIES : Zone IV

• ?sually partial lacerations

• Post op : P1P full e.tension3 +1P left free



EXTENSOR INJURIES : Zone V



EXTENSOR INJURIES : Zone VI

• *etter prognosis than %ore distal lesions :

– ?nlikely ha-e associated joint injuries

– Less potential for adhesion for%ation

– @reater tendon e.cursion

– Post op : dyna%ic splinting



EXTENSOR INJURIES : Zone VII

• 9ssociated with retinaculu% da%age

• Aonabsorbable sutures



EXTENSOR INJURIES : Zone VIII

• Multiple nonabsorbable sutures

• Post op : statis i%%obiliBation of the wrist in

)= – )C> e.tension3 M5P in (C – '=>



POSTOPERATIVE MANAGEMENT

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