Download PDF
Letter to Editor  |  Open Access  |  24 Aug 2017

Tips and tricks for getting more out of your delayed primary repair of ruptured flexor pollicis longus tendon

Views: 21063 |  Downloads: 1344 |  Cited:  0
Plast Aesthet Res 2017;4:135-6.
10.20517/2347-9264.2017.43 |  © 2017 OAE Publishing Inc.
Author Information
Article Notes
Cite This Article

Sir,

Primary tendon repairs are often difficult in patients with delayed presentation. Tendons are contracted and shortened with extensive scarring occurring along the path of the tendon. Pulleys and the wound bed can be filled with granulation tissue which obstructs the passage of the tendon. Many of such patients would then be treated with a two stage tendon reconstruction, which involves the insertion of a silicone rod for pseudosheath formation[1] before tendon grafting at a second stage. This however, would set the patient back for roughly six months, especially involving multiple visits to physiotherapy and being off work. We would like to describe several tips and tricks in our armamentarium and illustrate these using a case we recently encountered [Figure 1].

Tips and tricks for getting more out of your delayed primary repair of ruptured flexor pollicis longus tendon

Figure 1. Schematic diagram illustrating the tips and tricks used for getting more out a primary FPL tendon repair. FPL: flexor pollicis longus

A 40-year-old mechanic presented with a 5-week-old rupture of the flexor pollicis longus (FPL) at the interphalangeal joint (IPJ) of the left thumb. A plan for a two-stage reconstruction of the tendon was discussed with him and was scheduled for a silicone rod insertion. Bruner incisions to zone 3 were made and the distal end of FPL was seen but the proximal end had retracted to the wrist.

Our tips and tricks used were as follows:

1. Use of a size 6 feeding catheter attached to a saline-filled syringe for hydrodissection of the path. Palpation of the catheter through the skin can be performed to allow localisation of path.

2. Adequate debridement of granulation and scar tissue was performed along the path of the tendon, especially under the pulleys of the thumb. Pulleys were also stretched using a fine tooth artery clip for several seconds, which avoided any venting.

3. The FPL tendon found at the wrist level was delivered through a wrist incision and stretched under tension for 2 min using an artery clip. Le Viet’s releasing incisions can be performed at the tendon-muscle belly junction for added length if required.[2]

4. When attaching the FPL tendon to the feeding catheter, a gap is left when suturing the two together. Careful retraction of the feeding catheter with the tendon is then performed.

5. A combination of a two strand modified Kessler core suture and a mattress suture was used with a 3/0 prolene suture. A running epitendinous repair with 4/0 prolene was performed.

We tested our repair on table by flexing and extending the thumb IPJ five times, and ensured tendon gliding and excursion was not compromised. The thumb was splinted with a dorsal blocking splint in slight IPJ flexion. If on table tendon rupture or inadequate tendon excursion and gliding occurs despite the techniques performed above, a two-stage tendon reconstruction is then indicated.

Declarations

Authors’ contributions

Manuscript preparation: C.Y.Y. Loh, A. Tan

Manuscript review: M. Tare

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.

Patient consent

Obtained.

Ethics approval

Not required.

REFERENCES

1. Bassett CA, Carroll RE. Formation of a tendon sheath by silicone-rod implants. J Bone Joint Surg Am 1963;45:884-5.

2. Le Viet D. Flexor tendon lengthening by tenotomy at the musculotendinous junction. Ann Plast Surg 1986;17:239-46.

Cite This Article

Export citation file: BibTeX | EndNote | RIS

OAE Style

Loh CYY, Tan A, Tare M. Tips and tricks for getting more out of your delayed primary repair of ruptured flexor pollicis longus tendon. Plast Aesthet Res 2017;4:135-6. http://dx.doi.org/10.20517/2347-9264.2017.43

AMA Style

Loh CYY, Tan A, Tare M. Tips and tricks for getting more out of your delayed primary repair of ruptured flexor pollicis longus tendon. Plastic and Aesthetic Research. 2017; 4: 135-6. http://dx.doi.org/10.20517/2347-9264.2017.43

Chicago/Turabian Style

Charles Yuen Yung Loh, Alethea Tan, Makarand Tare. 2017. "Tips and tricks for getting more out of your delayed primary repair of ruptured flexor pollicis longus tendon" Plastic and Aesthetic Research. 4: 135-6. http://dx.doi.org/10.20517/2347-9264.2017.43

ACS Style

Loh, CYY.; Tan A.; Tare M. Tips and tricks for getting more out of your delayed primary repair of ruptured flexor pollicis longus tendon. Plast. Aesthet. Res. 2017, 4, 135-6. http://dx.doi.org/10.20517/2347-9264.2017.43

About This Article

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License (http://creativecommons.org/licenses/by-nc-sa/3.0/), which allows others to remix, tweak and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Data & Comments

Data

Views
21063
Downloads
1344
Citations
0
Comments
0
0

Comments

Comments must be written in English. Spam, offensive content, impersonation, and private information will not be permitted. If any comment is reported and identified as inappropriate content by OAE staff, the comment will be removed without notice. If you have any queries or need any help, please contact us at support@oaepublish.com.

0
Download PDF
Share This Article
Scan the QR code for reading!
See Updates
Contents
Figures
Related
Plastic and Aesthetic Research
ISSN 2349-6150 (Online)   2347-9264 (Print)

Portico

All published articles are preserved here permanently:

https://www.portico.org/publishers/oae/

Portico

All published articles are preserved here permanently:

https://www.portico.org/publishers/oae/