Flexor Tendon Injuries –Repair and Reconstruction-Flexor Tendon Repairs Techniques, Eponyms, and Evidence

Flexor Tendon Repairs Techniques, Eponyms, and Evidence

Pdf Summary

Flexor tendon repairs are a common surgical procedure, and there are several techniques and suture options available. However, there is no consensus on the best surgical technique, and repairs are often chosen based on familiarity, popularity, and technical difficulty. The goals of a good repair are easy suture placement, secured knots, minimal gapping at the repair site, and enough strength for early active postoperative motion.<br /><br />Two-strand repairs, such as the Pennington and Tajima modified Kessler repairs, are often used and have shown good biomechanical strength. Four-strand repairs, such as the cross-lock cruciate repair and Massachusetts General Hospital (MGH) repair, are considered the minimum for early motion exercises. The cross-lock cruciate repair has been shown to be biomechanically superior, while the MGH repair has the advantage of a larger suture purchase.<br /><br />Six-strand repairs, such as the Lim-Tsai, Tsuge, Savage, and modified Savage repairs, provide increased strength compared to two- and four-strand repairs. The eight-strand Winters-Gelberman repair is even stronger than six-strand repairs. Alternative repairs using barbed sutures and stainless steel wire have also shown potential for improved strength and reduced friction.<br /><br />Complications of flexor tendon repairs can include adhesions, rupture, and decreased range of motion. Adhesion formation can be reduced by the addition of an epitendinous stitch. A systematic review reported reoperation rates of 6%, rupture rates of 4%, and adhesion formation rates of 4%.<br /><br />Overall, the choice of surgical technique and suture type depends on the specific case and surgeon preference. Care must be taken to minimize complications and optimize the biomechanical strength of the repair.

Keywords

flexor tendon repairs

surgical procedure

techniques

suture options

surgical technique

two-strand repairs

four-strand repairs

six-strand repairs

eight-strand repairs

complications