flexor tendon injuries_utsav
DESCRIPTION
flexor tendon injuriesTRANSCRIPT
![Page 1: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/1.jpg)
Flexor Tendon InjuriesDr. Utsav Agrawal
![Page 2: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/2.jpg)
Anatomy
![Page 3: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/3.jpg)
![Page 4: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/4.jpg)
Camper’s Chiasma
FDS
FDP
![Page 5: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/5.jpg)
![Page 6: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/6.jpg)
![Page 7: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/7.jpg)
Examination1. Fractures or dislocation2. neurovascular injuries3. Examination of tendon injuries
![Page 8: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/8.jpg)
![Page 9: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/9.jpg)
InvestigationsClinical examinationRadiographyMRI
![Page 10: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/10.jpg)
Timing of surgeryprimary –within 24 hrsDelayed primary -1 to 10 daysSecondary – upto 4 wksLate secondary beyond 4 wks
If wound is clean, primary repair, along with care of neurovascular injury and fracture.
![Page 11: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/11.jpg)
EXPOSURES
![Page 12: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/12.jpg)
Core suturesEpitenon sutures – reduce bulk and increase strength
Core sutures – - careful handling and alignment of tendons - more dorsal suture placement better outcome - More sutures crossing the interaction site, more
strength - lacerations involving more than 60 % cross-section of
the tendon should be repaired - 4-0 braided sutures like capromid, polyester
Suture Configurations
![Page 13: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/13.jpg)
Bunnel Stitch
Kessler Stitch
![Page 14: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/14.jpg)
Masson-Allen Criss-cross
Modified kessler Tajima
![Page 15: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/15.jpg)
Epitenon suture
![Page 16: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/16.jpg)
Tendon to bone attachment
![Page 17: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/17.jpg)
![Page 18: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/18.jpg)
![Page 19: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/19.jpg)
![Page 20: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/20.jpg)
Leddy and Packer classification of FDP avulsion
![Page 21: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/21.jpg)
Leddy type I to be managed as early as possible, atleast within 3 wks
II and III can be managed upto 6 wksIf less than 1 cm distal stump available then
FDP advancement with tendon to bone attachment
in old and leddy I, keep instruments for tendon retrieval like infant feeding tube, paediatric sounds and tendon grafts.
Retrieval technique – sourmelis-mcgrouther
![Page 22: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/22.jpg)
Grafts
![Page 23: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/23.jpg)
![Page 24: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/24.jpg)
Post-operative immobilisation
![Page 25: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/25.jpg)
Complications Adhesion formationImplant failureGraft failurePulley disruptionQuadrigiaLumbrical plus fingerSynovitisInfectionFlexion deformity
![Page 26: Flexor tendon injuries_UTSAV](https://reader038.vdocuments.site/reader038/viewer/2022102616/549565aab479596a1c8b463b/html5/thumbnails/26.jpg)
THANK YOU