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Tenolysis of Flexor Tendons



- 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 tendon;
           - in order 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



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