RESEARCH ARTICLE


An Overview of the Management of Flexor Tendon Injuries



M Griffin1, S Hindocha*, 2, 3, D Jordan3, M Saleh4, W Khan5
1 Academic Foundation Trainee, Kingston Upon Thames, London, UK
2 Department of Plastic Surgery, Whiston Hospital, Warrington Road, L355DR, UK
3 Department of Plastic Surgery, Countess of Chester Hospital, Liverpool Road, Chester, CH21UL, UK
4 Ain Shams University, Khalifa El-Maamon St, Abbasiya Sq, Cairo 11566, Egypt
5 University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA74LP, UK


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Creative Commons License
© Griffin et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Plastic Surgery, Whiston Hospital, Warrington Road, L355DR, UK; Tel: 01244366265; Fax: 01244366265; hindocha2001@yahoo.com


Abstract

Flexor tendon injuries still remain a challenging condition to manage to ensure optimal outcome for the patient. Since the first flexor tendon repair was described by Kirchmayr in 1917, several approaches to flexor tendon injury have enabled successful repairs rates of 70-90%. Primary surgical repair results in better functional outcome compared to secondary repair or tendon graft surgery. Flexor tendon injury repair has been extensively researched and the literature demonstrates successful repair requires minimal gapping at the repair site or interference with tendon vascularity, secure suture knots, smooth junction of tendon end and having sufficient strength for healing. However, the exact surgical approach to achieve success being currently used among surgeons is still controversial. Therefore, this review aims to discuss the results of studies demonstrating the current knowledge regarding the optimal approach for flexor tendon repair. Post-operative rehabilitation for flexor tendon surgery is another area, which has caused extensive debate in hand surgery. The trend to more active mobilisation protocols seems to be favoured but further study in this area is needed to find the protocol, which achieves function and gliding but avoids rupture of the tendons. Lastly despite success following surgery complications commonly still occur post surgery, including adhesion formation, tendon rupture and stiffness of the joints. Therefore, this review aims to discuss the appropriate management of these difficulties post surgery. New techniques in management of flexor tendon will also be discussed including external laser devices, addition of growth factors and cytokines.

Keywords: Flexor tendon repair, flexor laceration, post operative mobilisation, hand injuries, tendon injuries.