Flexor Tendon Injuries Research Articles

Passive Mobilization With Place-and-Hold Versus Active Mobilization Therapy After Flexor Tendon Repair: 5-Year Minimum Follow-Up of a Randomized Controlled Trial

There is no consensus on the optimal postoperative rehabilitation program following flexor tendon repair. Some studies suggest a faster recovery after active mobilization, whereas other studies have failed to find any differences between active and passive mobilization at 12 months. To our knowledge, no prior randomized controlled trial has compared the long-term effects of these two approaches. This randomized controlled trial compared the long-term outcomes of active mobilization with those of passive mobilization in combination with place-and-hold. Sixty-four patients with a flexor tendon injury in zones I or II were included in the study. After surgery, patients were randomized to either active mobilization or passive mobilization with place-and-hold. Forty-seven patients were available for the 5-year minimum follow-up. Assessments included range of motion, grip strength, key pinch, as well as the Disabilities of the Arm, Shoulder, and Hand (DASH) and ABILHAND questionnaires. At the 5-year minimum follow-up, range of motion was significantly better in the group treated with passive mobilization with place-and-hold compared with the active mobilization group. Furthermore, there was a significant deterioration in the range of motion and an increased flexion contracture in the active mobilization group compared with 1 year after surgery. Grip strength deteriorated significantly in both groups from the 1-year to the 5-year minimum follow-up, but key pinch did not change. In both groups, DASH and ABILHAND scores improved from the 1-year to the 5-year minimum follow-up. Passive mobilization with place-and-hold following flexor tendon repair results in superior long-term outcomes compared with active mobilization. Therapeutic I.

Surgical treatment of children with tendon injuries of deep finger flexor tendons in the zone of fibrosynovial canals in pediatric patients: a review

Surgical treatment of children with tendon injuries of deep finger flexor tendons in the zone of fibrosynovial canals in pediatric patients: a review

Reliability and Validity of Ultrasound in Identifying Anatomical Landmarks for Diagnosing A2 Pulley Ruptures: A Cadaveric Study.

Background/Objectives: Rock climbing is becoming more popular, leading to an increased focus on diagnosing and treating related injuries. Finger pulley and flexor tendon injuries are common among climbers, with the A2 pulley being the most frequently affected. High-resolution ultrasound (US) is the preferred method for detecting pulley injuries. This study aimed to determine the reliability and validity of US in identifying anatomical landmarks for diagnosing A2 pulley ruptures. Methods: This study was cross-sectional, involving 36 fingers from 4 cadaver arms. A Canon Aplio i800 US machine was used to measure two anatomical landmarks: the midpoint of the proximal phalanx and the distal edge of the A2 pulley. For the first anatomical landmark, the length of the proximal phalanx (PP distance), and for the second landmark, the distance between the distal edges of the proximal phalanx and the A2 pulley ("A" distance), were measured. Measurements were performed by two sonographers and compared to a digital caliper measurement taken post-cadaver dissection. Observers were blinded during measurements to ensure unbiased results. Results: Overall PP distance measured by US (O1: 37.5 ± 5.3 mm, O2: 37.8 ± 5.4 mm) tended to be shorter than caliper measurements (O3: 39.5 ± 5.5 mm). The differences between sonographers were minimal, but larger when compared to caliper measurements. High reliability for PP distance measurement was observed, especially between sonographers, with an ICC average of 0.99 (0.98, 1.00). However, reliability was lower for the "A" distance, with significant differences between US and caliper measurements. Regarding validity, US measurements were valid when compared to caliper measurements for PP distance, but not as reliable for the "A" due to wider confidence intervals. While US can substitute caliper measurements for PP distance (LR, Y:O2, X:O3, -0.70 (-3.28-1.38), 0.98 (0.93 ± 1.04)), its validity for "A" distance is lower (LR, Y:O2, X:O3, -2.37 (-13.53-4.83), 1.02 (0.62-1.75)). Conclusions: US is a reliable and valid tool in identifying anatomical landmarks for diagnosing A2 pulley ruptures, particularly for detecting the midpoint of the proximal phalanx. This is important to differentiate between complete and partial A2 pulley tears. However, the measurement of the "A" distance requires further refinement. These findings support efforts to standardize US examination protocols and promote consensus in diagnostic methodology, though further research is needed to address the remaining challenges.

Biomechanical Comparison of Three Modified Kessler Techniques for Flexor Tendon Repair: Implications in Surgical Practice and Early Active Mobilization.

Objective: Managing flexor tendon injuries surgically remains challenging due to the ongoing debate over the most effective suture technique and materials. An optimal repair must be technically feasible while providing enough strength to allow for early active mobilization during the post-operative phase. This study aimed to assess the biomechanical properties of three modified Kessler repair techniques using two different suture materials: a conventional two-strand and a modified four-strand Kirchmayr-Kessler repair using 3-0 Prolene® (2s-KK-P and 4s-KK-P respectively), and a four-strand Kessler-Tsuge repair using 4-0 FiberLoop® (4s-KT-FL). Methods: Human flexor digitorum profundus (FDP) tendons were retrieved from Thiel-embalmed prosections. For each tendon, a full-thickness cross-sectional incision was created, and the ends were reattached using either a 2s-KK-P (n = 30), a 4s-KK-P (n = 30), or a 4s-KT-FL repair (n = 30). The repaired tendons were tested using either a quasi-static (n = 45) or cyclic testing protocol (n = 45). Maximum force (Fmax), 2 mm gap force (F2mm), and primary failure modes were recorded. Results: In both quasi-static and cyclic testing groups, tendons repaired using the 4s-KT-FL approach exhibited higher Fmax and F2mm values compared to the 2s-KK-P or 4s-KK-P repairs. Fmax was significantly higher with a 4s-KK-P versus 2s-KK-P repair, but there was no significant difference in F2mm. Suture pull-out was the main failure mode for the 4s-KT-FL repair, while suture breakage was the primary failure mode in 2s- and 4s-KK-P repairs. Conclusions: FDP tendons repaired using the 4s-KT-FL approach demonstrated superior biomechanical performance compared to 2s- and 4s-KK-P repairs, suggesting that the 4s-KT-FL tendon repair could potentially reduce the risk of gapping or re-rupture during early active mobilization.

WALANT vs standard anaesthesia in the management of flexor tendon injuries: A systematic review and meta-analysis

WALANT vs standard anaesthesia in the management of flexor tendon injuries: A systematic review and meta-analysis

Injury and Section of Flexors in Zone II

Flexor tendon repair is a challenging task in hand surgery, with numerous studies and publications on the subject. The incidence of flexor tendon injuries in India is estimated to be around 14/100,000-person years. The fingers are characterized by five zones: Zone I, Zone II, Zone III, Zone IV, and Zone V. Reparation of these zones involves flap extension, suturing, and band repair. However, tendon repair is fraught with complications, with the most catastrophic outcome being rupture. Tendon adhesions are a common consequence of the healing process and can be limited with atraumatic surgical techniques, robust repair, and early mobilization strategies. Ultrasound imaging is helpful in determining the continuity of the flexor tendon. Tenolysis surgery may be necessary if treatment is unsuccessful, but is generally recommended after three to six months.

Comparison of Kleinert versus Saint John protocol in Zone I/II flexor tendon injuries: A retrospective study

Background: There is no concrete evidence to define the optimal mobilization strategy following zone I/II flexor tendon repair. The Saint John Protocol is an active motion regime which utilizes wrist movement to facilitate better clinical outcomes. Our objective was to compare the outcomes of patients who underwent the conventional Kleinert protocol versus the Saint John protocol. Methods: 20 fingers in the Kleinert group and 18 fingers in the Saint John group were included in this retrospective study. Pain score, range of movement, grip strength, and complications were studied at 6 and 12 weeks postoperatively. Results: The Saint John protocol showed significantly less pain at 6 week (0.167 vs 1.08, P = 0.032) and less flexion contracture at the PIPJ at 6 weeks (3.33 vs 12.25, P = 0.032). Both groups showed similar rerupture rates (5.5% vs 5%). Conclusions: Saint John protocol demonstrated better clinical outcomes while not sacrificing the integrity of repair.

Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Regional Anesthesia with Tourniquet for Hand Flexor Tendon Repair Surgeries in Adults

Abstract Background Flexor tendon injuries represent a significant percentage of admissions in emergency departments in Egypt. A bloodless surgical field is important to perform a hand surgery. Traditionally, a tourniquet is used for hemostasis, and the standered anesthetic techniques utilized in hand surgery were general anesthesia, intravenous regional anesthesia, or brachial plexus block. Recently the evolving Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique where patient is operated on under local anesthesia and hemostasis is achieved via adrenaline could be a better choice. Aim of this work is to compare the intraoperative pain scores, induction time, operating time, blood loss, postoperative pain scores, and patient satisfaction with WALANT versus supraclavicular brachial plexus block (SC-BPB ) with tourniquet, in patients undergoing flexor tendon repair. Patients and Methods In the current study 52 patients who underwent flexor tendon intervention were divided randomly into two groups, each group consisting of 26 patients. Group A: Patients in this group received WALANT. Group B: Patients in this group received SC-BPB with a tourniquet applied to the arm. Results Intraoperative Wong-Baker Faces scale revealed no statistically significant difference in intraoperative pain scores in both groups, except during injection (p = 0.04). Tourniquet-related pain was reported in 23% of patients of SC-BPB group (p = 0.001). Induction time was significantly shorter in WALANT (p < 0.01) but time needed to obtain sufficient hemostasis is significantly more in WALANT than SC-BPB (p < 0.01) while surgical time was similar in both groups (p = 0.538). Blood loss in spite of being minimal it was statistically significant higher in WALANT (p < 0.01). Conclusion WALANT anesthesia was found to be better alternative to SC-BPB in flexor tendon repair surgeries in adults being more simple technique and no need for special skills or ultrasound device, less time consumed in induction and less injection pain also no tourniquet-related pain, intraoperative active motion of the hand is preserved facilitating surgical technique, better effect on postoperative analgesia and more patient and surgeon satisfaction.

Effect of Heparin on Post-Operative Ultrasonographic Changes in Flexor Digitorum Profundus Tendon Trauma Of The Hand

Abstract Background Flexor tendon injuries especially zone II are a challenging problem for both surgeons and patients as they need careful post-operative early physiotherapy to decrease adhesions and improve gliding which carry risk of early tendon rupture. Many drugs were tested for their role in decreasing paratendinous adhesions and enhance clinical outcome, this study by ultrasound examination test effect of intraoperative addition of heparin in limiting paratendinous adhesions and improving clinical outcome. Aim of the Work to evaluate the effect of intraoperative heparin addition in preventing postoperative adhesions and on clinical outcome. Patients and Methods This clinical trial study included 21 patients with 31 surgically repaired zone II flexor digitorum profundus tendons. The 21 Patients were divided randomly into two groups, group A (study group) with heparin injection during surgical repair and group B (control group) without heparin injection, with a total number of eleven patients in group I and ten patients in group II. Results There was no statistically significant difference between the two groups in tendon margins, gliding or granulation tissue severity, which can support why it does not affect clinical outcome. There was no statistically significant relation between the heparin injection and tenosynovitis although heparin is known for its anti-inflammatory effect. Tendon re rupture was more presented in heparin injected group yet not of statistical significance. Conclusion The intraoperative heparin injection at repair site didn’t show any significance in enhancing clinical outcome or in limiting paratendinous adhesions. Although it wasn’t of statistical significant but tendon re-rupture was more seen in cases managed with heparin injection group so heparin injection is not recommended in treatment such cases yet further investigations are needed.

Ring-Embedded Finger Over Proximal Interphalangeal Joint with Preserved Neurovascularization: A Case Report and Literature Review.

We present a unique case of a 45-year-old man with his right middle finger embedded with rings. Limited finger flexion was noted because of flexor tendon injury caused by the dorsal migration of the embedded ring through joint. The rings were removed under anesthesia, resulting in the resolution of swelling and recover of osseous structure. Follow-up examinations revealed no residual edema or numbness, indicating preserved neurovascularization, despite the dorsal migration of the ring. Our unique case reveals continuous finger ring migration without compromising neurovascular bundles, with review of 30 cases emphasizing the importance of psychiatric consultation. Timely intervention yielded nearly half of patients achieving full recovery.

Mesenchymal Stromal Cells for the Enhancement of Surgical Flexor Tendon Repair in Animal Models: A Systematic Review and Meta-Analysis.

Flexor tendon lacerations are primarily treated by surgical repair. Limited intrinsic healing ability means the repair site can remain weak. Furthermore, adhesion formation may reduce range of motion post-operatively. Mesenchymal stromal cells (MSCs) have been trialled for repair and regeneration of multiple musculoskeletal structures. Our goal was to determine the efficacy of MSCs in enhancing the biomechanical properties of surgically repaired flexor tendons. A PRISMA systematic review was conducted using four databases (PubMed, Ovid, Web of Science, and CINAHL) to identify studies using MSCs to augment surgical repair of flexor tendon injuries in animals compared to surgical repair alone. Nine studies were included, which investigated either bone marrow- or adipose-derived MSCs. Results of biomechanical testing were extracted and meta-analyses were performed regarding the maximum load, friction and properties relating to viscoelastic behaviour. There was no significant difference in maximum load at final follow-up. However, friction, a surrogate measure of adhesions, was significantly reduced following the application of MSCs (p = 0.04). Other properties showed variable results and dissipation of the therapeutic benefits of MSCs over time. In conclusion, MSCs reduce adhesion formation following tendon injury. This may result from their immunomodulatory function, dampening the inflammatory response. However, this may come at the cost of favourable healing which will restore the tendon's viscoelastic properties. The short duration of some improvements may reflect MSCs' limited survival or poor retention. Further investigation is needed to clarify the effect of MSC therapy and optimise its duration of action.

The effect of the number of strands and knot throws of core suture techniques on the mechanical properties of the repaired flexor tendon.

Flexor tendon injury is a common hand trauma that requires surgical repair. The objective was to compare the repaired strength and gliding resistance with a varied number of repair strands and of square knots using a two-strand-overhand locking (TSOL) knot. First, isolated suture loops with different number of suture strands and number of closing knots were compared in mechanical strength and failure mode. Then, 90 flexor digitorum profundus (FDP) tendons from turkey digits were used for the tendon repair experiment. Both phases followed a similar 3 × 3 matrix comparing the knot type including TSOL+1SK (square knot), TSOL+2SK, and TSOL+3 SK and repair techniques including two-, four-, and six-strand repairs techniques respectively. The repaired tendons were tested for tendon resistance against pulley (friction), maximum force, force at 2 mm displacement, stiffness, and failure mode. Increasing the number of strands and closing square knots increases the tensile strength and stiffness of flexor tendon repairs and isolated suture loops without a significant effect on tendon friction. An increase in the number of square knots have shown increased strength only in Pennington repair, which correlated with the increased number of knot unraveling, a weak knot failure model. Our data demonstrated that increasing the number of strands is effective for improving the overall strength of tendon repair. When a two-strand repair is chosen, increasing knot number can improve repair strength. However, the number of knots appears not affecting repair strength in six-strand repair technique.

The major league baseball pitch clock: First year analysis of pitcher injuries

Recently, star pitchers in Major League Baseball (MLB) have faced devastating elbow injuries, causing some to question whether implementation of the MLB pitch clock during the 2023 season has led to a higher rate of elbow injuries among pitchers. This study aims to determine if implementation of the MLB pitch clock in the 2023 MLB season affected the injury rate in pitchers. Injury data was collected for the 2021, 2022, and 2023 MLB seasons using the fangraphs.com injury database. Incidence rate ratio was calculated to compare the injury rate for the 2023 season to the 2021 and 2022 seasons. A z-test for proportions was used to determine significance levels. The 2023 season showed a decrease in the rate of the total number of injuries when compared to the 2021 (P=0.01) and 2022 (P=0.02) seasons. There was no statistical difference in the rate of Tommy John Surgery, Flexor Tendon Injuries, or other cause elbow injuries. Following implementation of the MLB pitch clock during the 2023 season, the total number of injuries decreased, but there was no change in the rate of elbow injuries in pitchers compared with the 2021 and 2022 MLB seasons. Future studies are needed to determine if the pitch clock has a longitudinal effect on injuries.

Prognostic value of power doppler ultrasonography for equine superficial digital flexor tendon injury in thoroughbred racehorses

The potential value of hypervascularity detected with power Doppler ultrasonography (PDU) within equine superficial digital flexor tendon (SDFT) as a prognostic factor of SDFT injury is not clear. The purpose of this study was to test the hypothesis that hypervascularity within SDFT is one of the risk factors for subsequent severe SDFT injury and to evaluate the prognostic value. A prospective cohort study of 97 Thoroughbred racehorses without any clinical signs of SDFT injury was conducted. Six variables of age, body weight, sex, the cross-sectional area of SDFT, PDU signal within SDFT and experience of steeplechase were assessed for the possibility of risk factors of subsequent SDFT injury in follow-up period of 1 year. Multivariable logistic regression analyses were used for assessment of the odds ratios (ORs) and 95 % confidence intervals (CIs) of SDFT injury. Multivariable logistic regression analysis revealed that the PDU signal within SDFT was a risk factor for the development of SDFT injury in follow-up period (P = 0.017). The adjusted OR of SDFT injury was significantly higher in PDU positive group than in PDU negative group (OR 3.17, 95 % CIs 1.20–8.35). Although further studies are required, these results would be useful for early detection and/or prevention of development for clinical severe SDFT injury.

Four-Strand Modified Kessler versus Cruciate Technique for Repair of Zone Two Flexor Tendon Injuries: A Randomized Controlled Trial

Four-Strand Modified Kessler versus Cruciate Technique for Repair of Zone Two Flexor Tendon Injuries: A Randomized Controlled Trial

Current trends in the prevention of adhesions after zone 2 flexor tendon repair.

Treating flexor tendon injuries within the digital flexor sheath (commonly referred to as palmar hand zone 2) presents both technical and logistical challenges. Success hinges on striking a delicate balance between safeguarding the surgical repair for tendon healing and initiating early rehabilitation to mitigate the formation of tendon adhesions. Adhesions between tendon slips and between tendons and the flexor sheath impede tendon movement, leading to postoperative stiffness and functional impairment. While current approaches to flexor tendon repair prioritize maximizing tendon strength for early mobilization and adhesion prevention, factors such as pain, swelling, and patient compliance may impede postoperative rehabilitation efforts. Moreover, premature mobilization could risk repair failure, necessitating additional surgical interventions. Pharmacological agents offer a potential avenue for minimizing inflammation and reducing adhesion formation while still promoting normal tendon healing. Although some systemic and local agents have shown promising results in animal studies, their clinical efficacy remains uncertain. Limitations in these studies include the relevance of chosen animal models to human populations and the adequacy of tools and measurement techniques in accurately assessing the impact of adhesions. This article provides an overview of the clinical challenges associated with flexor tendon injuries, discusses current on- and off-label agents aimed at minimizing adhesion formation, and examines investigational models designed to study adhesion reduction after intra-synovial flexor tendon repair. Understanding the clinical problem and experimental models may serve as a catalyst for future research aimed at addressing intra-synovial tendon adhesions following zone 2 flexor tendon repair.

Plastic and Reconstructive Surgery in the Wake of the Eid al-Adha: A Single-Center, Five-Year Investigation.

(1) Background: The Festival of Sacrifice, commonly known as Eid al-Adha, has a profound religious and cultural impact on nations with a Muslim majority. This festival is celebrated every year in Muslim countries; however, it is a time in which patients present to the emergency department with serious injuries. In our study, we examined current injuries occurring during Eid al-Adha in one of the largest hospitals in Türkiye, providing the largest patient population to date. This included mapping tendon and maxillofacial injuries, a first in the literature. To the best of our knowledge, this is the largest case series of injuries sustained during Eid al-Adha. The significance of this study lies in its potential to significantly benefit patients and healthcare systems by providing reference data. (2) Methods: Patients admitted to Ankara City Hospital during Eid al-Adha between 2019 and 2023 were examined. The demographic characteristics, injury patterns, and injury sites of patients admitted on the four days of Eid al-Adha were collected and analyzed. Maxillofacial traumas during the festival were analyzed. Tendon injuries on the left hand, which is the most commonly injured body part in the literature, were mapped into a figure. To compare the change in the number of patients, a comparison was made with the number of patients in our hospital for four consecutive days 2 weeks before Eid. Statistical analysis was performed using IBM SPSS Statistics for Windows. (3) Results: A total of 610 patients, including 101 female and 509 male patients, were included in this study. A statistically significant increase (p < 0.001 for all years) in hospital admission due to injury was observed. Individuals between the ages of 30 and 40 years were the most frequently admitted patients (n = 182, 29.8%). Knife injuries were significantly more common in all patients (p < 0.001). When the total number of patients was evaluated in terms of injured areas where patients present to the emergency department, left-hand injuries were found to be significantly more common than injuries in other areas (p < 0.001 for all). The extensor pollicus longus tendon was the most commonly injured tendon among all extensor and flexor tendon injuries (n = 104). The most commonly injured tendon was the flexor tendon in zone 2 of the first finger (n = 45). This study showed that injuries to the extensor tendon in zone 1 of the fifth finger, the flexor tendon in zone 4 of the first finger, and the flexor tendon in zone 1 of the fifth finger were never seen. Twenty-five patients with maxillofacial injuries were admitted to the hospital. Orbital floor fractures were the most common type of maxillofacial injury. The anesthesia technique we preferred for all patients was local anesthesia (n = 267). Wide-awake local anesthesia no tourniquet (WALANT) was the second most preferred anesthetic technique. The number of patients who were selected in a random 4-day period for each year were compared with the number of patients who came during Eid al-Adha. The Mann-Whitney U tests revealed a significant increase in injuries on the first day of Eid al-Adha compared to non-festival days (p < 0.001). However, no significant differences were observed on the subsequent days or in the overall injury counts during the festival period (p = 0.841 for day 2, p = 0.151 for day 3, p = 0.310 for day 4). (4) Conclusions: According to this study, which is the largest known case series in the literature, the number of patients admitted to the hospital increased annually. In our study, we observed a significant increase in injuries only on the first day of Eid al-Adha compared to a randomly selected 4-day period of the same year. Left-hand extensor tendon injuries from a knife were the most common injuries in middle-aged men. The extensor pollicis longus tendon was the most commonly injured extensor tendon, with zones 3 and 4 being the most commonly affected. The flexor pollicis longus tendon was the most commonly injured flexor tendon in zone 2. During this period, patients may not only need hand surgery but also maxillofacial plastic surgery. We recommend, in addition to the indications I,n the literature that during Eid al-Adha, the WALANT technique should be widely adopted in patients where local anesthesia will be insufficient. We also recommend utilizing a diagram to manage the patient load during Eid al-Adha and prevent overburdening the healthcare system.

A systematic review of patient outcomes for primary pediatric flexor tendon repairs

BackgroundLiterature on pediatric flexor tendon repairs remains sparse. Given the various repair techniques and rehabilitation protocols available, the aim of this systematic review is to investigate outcomes of primary pediatric flexor tendon repairs. MethodsMEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases were searched from inception to June 2022 in concordance with PRISMA guidelines. Studies were included if patients were under the age of 18, sustained a flexor tendon injury repaired primarily, and had documented functional outcomes. Quality assessment was completed using the Newcastle-Ottawa Scale. The study was registered with PROSPERO (CRD42018089089). ResultsThis study includes 20 articles representing 577 patients with 748 injured digits, most frequently injured by a laceration from glass. The number of tendon injuries in zones I, II, III, IV, and V were 78, 431, 62, 2, and 19, respectively. In total, 594 FDP, 374 FDS, and 77 FPL tendons were lacerated. Concurrent digital nerve injuries occurred in 251 digits. Time of repair was 15 ​h–187 days post-injury, most commonly via the modified Kessler (n ​= ​266 digits) and Kessler (n ​= ​162 digits). Post-operatively, 170 patients were immobilized and 261 patients underwent early active (n ​= ​96) or passive (n ​= ​165) protocols. Functional outcomes were reported in 466 digits (excellent ​= ​306, good ​= ​132, fair ​= ​19, and poor ​= ​9, per the respective assessment tool used). There were 15 tendon ruptures. ConclusionsDespite heterogeneity in both operative and post-operative protocols, there is low level evidence that low complication rates and good outcomes are expected following primary repair of pediatric flexor tendons.

Flexor Tendon Grafting as Reoperative Procedure for Injuries within Fingers and Thumb

Background. The reoperation rate reported in the literature in cases of flexor tendon injuries within the fingers and thumb is about 20%, but the functional results of these reoperations are barely discussed.&#x0D; The aim of the study was to evaluate the results of flexor tendon grafting performed as a redo procedure in patients who had previously underwent unsuccessful flexor tendon surgery.&#x0D; Methods. This study reports the outcomes of deep flexor tendon and flexor pollicis longus tendon grafting in 122 fingers of 109 patients depending on two factors — the type of the first failed surgery (tendon suture in 51 fingers vs grafting in 71 fingers) and the type of the medical unit where the failed procedure had been performed (hand surgery department in 76 cases vs general trauma unit in 46 cases).&#x0D; Results. Our reoperative grafting procedures led to excellent results in 13 fingers of 51 (25.5% [95% CI: 14–40]) after failed tendon suture and in 32 fingers of 71 (45.1% [95% CI: 33–57]) after failed previous grafting, difference is statistically significant (÷2 = 4.888; p = 0.027). Failed surgeries performed at the hand surgery departments were redone with 48.7% [95% CI: 37–60] of excellent results (in 37 fingers of 76) and 14.5% [95% CI: 7–24] of fair results (in 11 fingers of 76). Failed surgeries performed at the general trauma units were redone with 17.4% [95% CI: 8–31] of excellent results (in 8 fingers of 46). This value statistically significantly differed from the hand surgery departments group: ÷2 = 12.054; p = 0.001. For a total, excellent results were obtained in 36.9% [95% CI: 28–46] (in 45 fingers of 122) of reoperative grafting procedures and good results in 34.5% [95% CI: 26–43] (in 42 fingers of 122).&#x0D; Conclusions. Analysis of the functional results of deep flexor tendon and flexor pollicis longus tendon grafting performed as a reoperative procedure showed that the excellent results with full finger function were achievable in patients who had previously undergone unsuccessful flexor tendon surgery in zone 2. But in general, the rates of motion recovery were significantly lower than in uncomplicated cases, even with a long history of injury. The worst functional results of reoperations were in patients who had previously been unsuccessfully operated in non-specialized medical units.

The value of local dexmedetomidine as an adjuvant to ultrasound-guided wide awake local anesthesia no tourniquet (WALANT) in flexor tendon repair surgeries: a randomized controlled trial

BackgroundThe Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique allows intraoperative motor assessment of tendon repair integrity of the hand compared with general anesthesia or brachial plexus block. No studies have tested the effect of adding dexmedetomidine to lidocaine on the analgesic properties of the WALANT technique, which is the aim of our study.MethodsA total of 128 patients aged more than 18 years were scheduled for surgical flexor tendon injury repair using WALANT technique. Patients were divided into two equal groups. Ultrasound-guided subcutaneous injection of lidocaine 1% with dexmedetomidine (1 µg/kg), Group D, or without dexmedetomidine, Group C, was performed at four points: proximal to the wrist joint, the distal forearm, palm region, and proximal phalanges. The primary outcome was total morphine consumption throughout the first postoperative day. Secondary outcomes included number of patients requiring rescue analgesia, time to first analgesic request, and pain score.ResultsTotal morphine consumption was significantly (P < 0.001) lower in group D (2.66 ± 0.998) than in group C (3.66 ± 1.144) mg. Number of patients requiring rescue analgesia was significantly (P < 0.001) lower in group D (54.7% (35)) than group C (100.0% (64)). The time for first request for analgesia was significantly (P < 0.001) longer in group D (11.31 ± 6.944) than in group C (5.91 ± 4.839) h. Pain score was significantly higher in group C than D at three (P < 0.001), and six (P = 0.001) hours (P = 0.001) postoperatively.ConclusionDexmedetomidine significantly improves the analgesic quality of WALANT when added to lidocaine with less opioid consumption.Trial registration(ID: PACTR202203906027106; Date: 31/07/2023).