- Discussion:
- w/ partial flexor tendon laceration which is proximal to A1 pulley:
- enlarge the laceration if necessary;
- if tendon is beveled, resect beveled edged
- partially severed tendon should not be repaired if at least 30-40% of the tendon remains intact;
- if level of paritial flexor tendon laceration is within digital sheath:
- attempt to observe tendons as pt fully flexes & extends finger;
- in the report by Al-Qattan MM, et al, the authors evaluated the role of conservative treatment in partial
flexor tendon injuries;
- over a 5-year-period 15 patients with zone II partial flexor tendon lacerations that were larger than half the width of the tendon were treated conservatively without tendon suturing;
- surgical exploration was done with a digital block and the flexor tendons were observed as the patient fully extended and flexed the finger;
- if present, the cause of triggering was determined and eliminated by trimming any beveled tendon edge, resection of the involved pulleys, and repair of the flexor sheath;
- early protected mobilization was started the first day after injury using a dorsal splint.
- at 4 weeks after injury the splint was removed and exercises against resistance were started.
- ref: Conservative management of zone II partial flexor tendon lacerations greater than half the width of the tendon
- Complications of Partial Rupture:
- external or internal triggering of finger & entrapment;
- if triggering persists, the sheath is opened, the tendon is repaired, & sheath is closed;
- potential complication of internal triggering is prevented by repair of sheath & early motion or repair of tendon & resection of the C-1 pulley;
- external triggering is prevented by early motion and partial resection of the A1 pulley;
- entrapment is prevented by resection of the beveled edge of the tendon and repair of the sheath;
- when A2 or A4 tendons are injured, consider repair over a silicone elastomer rod and subsequently removing rod & inserting a flexor tendon graft;
- loss of A2 or A4 pulley results in bow string of flexor tendon across PIP & permanent flexion contracture of joint, which is extremely difficult to correct
Clinical Treatment of Partial Tendon Lacerations without Suturing and with Early Motion.