Flexor Tendon Injuries vol 21 2 May

TOC.pdf......Page 1 01.pdf......Page 4 02.pdf......Page 8 Flexor tendon injuries......Page 9 History of Flexor Tendon Repair......Page 11 References......Page 14 Tendon anatomy......Page 16 Time-dependent factors......Page 17 Dynamics of flexor tendons......Page 19 Biomechanics of the flexor pulley system......Page 20 Digital fibro-osseous canal......Page 21 Flexor digitorum profundus......Page 23 Flexor digitorum superficialis......Page 25 Models of flexor tendon function......Page 26 Biomechanics of flexor tendon repairs......Page 28 Tendon forces......Page 29 References......Page 30 Flexor tendons: anatomy and surgical approaches......Page 37 Surgical approaches......Page 38 Summary......Page 42 References......Page 43 Tendon structure and nutrition......Page 44 Biomechanics......Page 45 Repair site biochemistry......Page 46 References......Page 47 Zone I flexor tendon injuries......Page 52 References......Page 55 Clinical history and physical examination......Page 57 Indications for surgery......Page 58 Surgical technique......Page 60 Pitfalls......Page 62 References......Page 63 Anatomy......Page 64 Diagnosis......Page 65 Postoperative considerations......Page 67 Outcomes......Page 68 References......Page 69 Tendon healing......Page 70 Tendon......Page 71 Vascular......Page 72 Nerves......Page 74 Skin......Page 75 Replantation, revascularization, and amputation......Page 77 Summary......Page 78 References......Page 79 Outcomes of flexor tendon repair: an overview of experience over the past 15 years......Page 81 Adhesion formation......Page 83 Repair rupture......Page 84 Surgical skills......Page 85 Evaluation of outcome and possible modifications......Page 86 Stronger surgical repairs......Page 87 Sheath/pulley management......Page 88 Optimization of rehabilitation regimen......Page 89 References......Page 90 Indication and timing......Page 93 Technique......Page 94 Indwelling catheter......Page 96 Results......Page 97 References......Page 98 Division of the flexor digitorum profundus and superficialis......Page 100 Indications......Page 101 Surgical technique......Page 102 Surgical technique......Page 106 Flexor tendon grafting summary......Page 107 Anesthesia and tourniquet......Page 108 Surgical technique......Page 109 Postoperative considerations......Page 114 Flexor tenolysis summary......Page 115 Indications......Page 116 Surgery technique: stage one......Page 117 Surgery technique: stage two......Page 119 Summary......Page 120 References......Page 121 Function of the pulleys......Page 125 Reconstructive options......Page 126 Triple loop technique......Page 127 Lister’s technique......Page 128 Complications......Page 129 References......Page 130 Diagnosis......Page 132 Rehabilitation......Page 133 Repair results......Page 134 References......Page 135 Immobilization program......Page 136 Kleinert program......Page 137 Early active motion......Page 138 Stage I......Page 141 Rehabilitation after tenolysis......Page 142 References......Page 143 The future of flexor tendon surgery......Page 145 Cell-based strategies......Page 146 Molecular medicine......Page 147 Gene therapy......Page 148 References......Page 149 19.pdf......Page 152 TOC.pdf 1 01.pdf 4 02.pdf 8 03.pdf 9 tlink1 9 Flexor tendon injuries 9 04.pdf 11 History of Flexor Tendon Repair 11 References 14 05.pdf 16 Biomechanics of the Flexor Tendons 16 Tendon anatomy 16 Mechanical properties of tendon 17 Time-dependent factors 17 Dynamics of flexor tendons 19 Biomechanics of the flexor pulley system 20 Components of the flexor pulley system 21 Transverse carpal ligament 21 Palmar aponeurosis pulley 21 Digital fibro-osseous canal 21 Pulley biomechanics and rock climbing 23 Finger-moving tendons 23 Flexor digitorum profundus 23 Flexor digitorum superficialis 25 Lumbricals 26 Models of flexor tendon function 26 Clinical applications 28 Biomechanics of flexor tendon repairs 28 Testing methods 29 Tendon forces 29 References 30 06.pdf 37 Flexor tendons: anatomy and surgical approaches 37 Surgical approaches 38 Summary 42 References 43 07.pdf 44 Flexor Tendon Biology 44 Tendon structure and nutrition 44 Biomechanics 45 The repair site gap 46 Repair site biochemistry 46 The future of intrasynovial tendon repair and rehabilitation 47 References 47 08.pdf 52 Zone I flexor tendon injuries 52 References 55 09.pdf 57 Acute flexor tendon repairs in zone II 57 Clinical history and physical examination 57 Indications for surgery 58 Surgical technique 60 Postoperative rehabilitation 62 Pitfalls 62 Summary 63 References 63 10.pdf 64 Treatment of acute flexor tendon injury: zones III-V 64 Anatomy 64 Etiology 65 Diagnosis 65 Treatment 67 Postoperative considerations 67 Outcomes 68 Summary 69 References 69 11.pdf 70 Complex Injuries Including Flexor Tendon Disruption 70 Types of complex flexor tendon injuries 70 Tendon healing 70 Treatment 71 General concepts 71 Tendon 71 Bone and joint 72 Vascular 72 Nerves 74 Skin 75 Replantation, revascularization, and amputation 77 Summary 78 References 79 12.pdf 81 Clinical outcomes associated with flexor tendon repair 81 Outcomes of flexor tendon repair: an overview of experience over the past 15 years 81 Factors affecting outcome of flexor tendon repair 83 Adhesion formation 83 Repair rupture 84 Joint stiffness 85 Extent of injuries 85 Surgical skills 85 Evaluation of outcome and possible modifications 86 Approaches to improve outcome 87 Stronger surgical repairs 87 Sheath/pulley management 88 Optimization of rehabilitation regimen 89 Biologic approaches 90 Summary 90 References 90 13.pdf 93 Flexor Tenolysis 93 Preoperative consideration 93 Indication and timing 93 Surgical technique 94 Anesthesia 94 Technique 94 Adjunctive modalities 96 Steroids 96 Interpositional devices 96 Indwelling catheter 96 Postoperative management 97 Results 97 Complications 98 Summary 98 Acknowledgments 98 References 98 14.pdf 100 Delayed treatment of flexor tendon injuries including grafting 100 Free tendon grafts 100 Division of the flexor digitorum profundus and superficialis 100 Indications 101 Donor tendons 102 Surgical technique 102 Postoperative care 106 Intact flexor digitorum superficialis 106 Surgical technique 106 Flexor tendon grafting summary 107 Flexor tenolysis 108 Indications 108 Timing 108 Operative considerations 108 Anesthesia and tourniquet 108 Surgical technique 109 Postoperative considerations 114 Flexor tenolysis summary 115 Flexor tendon reconstruction 116 Staged flexor tendon reconstruction with implantation of a silicone implant 116 Indications 116 Surgery technique: stage one 117 Surgery technique: stage two 119 Staged flexor tendon reconstruction: summary 120 Summary 120 References 121 15.pdf 125 Flexor Tendon Pulley Reconstruction 125 Anatomy of the pulley system 125 Function of the pulleys 125 Reconstructive options 126 Basic principles 127 Techniques 127 Kleinert/Weilby technique 127 Triple loop technique 127 Karev-belt-loop technique 128 Lister’s technique 128 Loop and a half technique 129 Synthetic materials 129 Clinical studies 129 Complications 129 Summary 130 References 130 16.pdf 132 Pediatric flexor tendon injuries 132 Diagnosis 132 Technique 133 Rehabilitation 133 Complications 134 Delayed diagnosis 134 Postoperative tendon rupture 134 Tendon adhesions 134 Repair results 134 Summary 135 References 135 17.pdf 136 Rehabilitation after flexor tendon repair, reconstruction, and tenolysis 136 Flexor tendon primary repair rehabilitation 136 Immobilization program 136 Controlled motion programs 137 Kleinert program 137 Duran program 138 Early active motion 138 Rehabilitation after flexor tendon reconstruction 141 Passive tendon implant 141 Stage I 141 Stage II 142 Active tendon implant 142 Stage I 142 Stage II 142 Rehabilitation after tenolysis 142 Summary 143 References 143 18.pdf 145 The future of flexor tendon surgery 145 Biology of flexor tendon repairs 146 Biologic advances 146 Cell-based strategies 146 Molecular medicine 147 Gene therapy 148 Summary 149 References 149 19.pdf 152