- See:
Technique of Free Tendon Grafting;
- Discussion:
- indications for tenolysis include failure to improve ROM after 3 months;
- if patient has had previous flexor tendon repair, surgery should be delayed until 6 months post op (inorder to avoid tendon rupture);
- consider using a wrist block and propofol anesthesia, so that the patient can demonstrate active motion in the operating room (indicating
whether the tenolysis has been successful);
- surgical statedgy involves creating small windows in the flexor tendon sheath, and using a periosteal elevator to elevate adhesions off the tedon;
- inorder to avoid having to make multiple incisions, loop a 24 gauge wire around the tendon and push it along the tendon sheath (along the volar and dorsal sides);
- the wire will either break up adhesions, or will direct the surgeon to where resistant adhesions are located;
- vigorous postoperative ROM is a must;
- if tenolysis does not achieve sufficient ROM, repeated tenolysis is not indicated;
- tenolysis should not take place before than 6 months after repair, because it may lead to tendon rupture;
- outcome is not always consistent;
- if tenolysis does not appear possible, the surgeon should move on to
staged flexor tendon repair;
- Complications:
- rupture of tendon repair;
- edema;
- neurovascular injury;
- rupture of flexor pulleys;
Flexor tenolysis. JW Strickland. Hand Clinics. Vol 1. 1985. p 121-132.
Tenolysis and capsulectomy after hand fractures. LH Schneider. CORR. Vol 327. 1996. p 72-78.
Complications in phalangeal and metacarpal fracture management: Results of tenolysis. J Creighton and J. Steichen. Hand Clinics. Vol 10: p 111. 1994.
