- extends from distal end of transverse retinacular ligament to proximal margin;
- combined nerve - tendon procedure may be delayed for 21 days if wound is contaminated, if crushing trauma has occurred;
- median nerve management: (nerve repair)
- lacerations of flexor tendons within the carpal canal are typically assoc w/ partial or complete laceration of median nerve;
- nerves should be repaired first and the tendons last;
- median nerve may be repaired primarily in a clean wound;
- median nerve is aligned by noting the proximal and distal central arteries, and by proximal and distal electric stimulation (< 48 hrs);
- delayed electrical stimulation is possible with the patient awake;
- distal nerve, however, may not show motor & sensory fibers stimulation;
- tension is removed from nerve suture line by flexing wrist 30 deg and MP joints 60 deg;
- post op:
- digit can be manipulated toward extension, provided wrist in maintained in 30 deg of flexion;
- main complication formation of adhesions between the flexor tendons and the carpal walls;
- Discussion: Zone V:
- extends from the proximal transverse carpal ligament at the wrist to musculocotinous junction of flexor tendons in forearm;
- in this area there may be concomitant ulnar nerve & artery damage as well as radial artery & median nerve damage;
- primary repair of the arteries is usually indicated;
- if wound is contaminated, arteries are repaired and delayed repair of tendons and nerves is planned;
- post op:
- wrist is maintained in volar flexion for 21 days and gradually brought into dorsiflexion during the subsequent 6 weeks
- references:
- Optimizing independent finger flexion with zone V flexor repairs using the Massachusetts General Hospital flexor tenorrhaphy and early protected active motion.
- Dynamic Splinting With Early Motion Following Zone IV/V and TI to TIII Extensor Tendon Repairs