TENDON SUTURE

BY :

UKI

HISTORY
Mode of injury : sharp objects or blunt
injury
Finger position when the injury took place

PHYSICAL EXAMINATION
LOOK :
Position of the injured finger(s)
Location of the wound

FEEL : Pain
MOVE : Range of motion

Basic Tendon Techniques

The purpose of tendon suture is :
- to approximate the ends of a tendon

- to fasten one end of a tendon to adjoining

tendons
- to bone and to hold this position during
healing.

Six characteristics of an ideal tendon

repair :
(1). easy placement of sutures in the tendon
(2). secure suture knots
(3). smooth juncture of tendon ends
(4). minimal gapping at the repair site
(5). minimal interference with tendon
vascularity
(6). sufficient strength throughout healing to
permit application
of early motion
stress to the tendon.

SUTURE MATERIAL

Absorbable sutures (catgut, Dexon, Vicryl), become

weak too early after surgery to be effective in tendon
repair.
Synthetic sutures and nylon maintain their resistance
to disrupting forces longer than polypropylene
(Prolene) and polyester suture,
Polyester sutures (Ticron; Mersilene) provide
sufficient resistance to disrupting forces and gap
formation, handle easily, and have satisfactory knot

FLEXOR TENDON

ANATOMY

TREATMENT : Zone I

TREATMENT : Zone II
Treated with primary or delayed primary
repair (2 14 days post injury)
Both of FDP and FDS repair versus FDP repair
only
Extension splinting

TREATMENT : Zone III

Treated with primary or delayed primary
repair (up to 3 weeks after injury)
Both of FDP and FDS should be repair

TREATMENT : Zone IV & V

Primary repair is recommended
Delayed primary repair should be done
within 3 weeks of injury

INCISIONS

SUTURE TECHNIQUES

SUTURE TECHNIQUES

SUTURE TECHNIQUES

POSTOPERATIVE MANAGEMENT

COMPLICATIONS
Zone I : flexion contracture at DIP & PIP,
tenodesis, detachment
Zone II V : tendon rupture

EXTENSOR TENDON

ANATOMY

Extensor Tendon Rupture

For a closed extensor tendon rupture from its
insertion into the
distal phalanx, the treatment
usually is nonsurgical
-

- The distal interphalangeal joint is constantly held in

hyperextension on a splint for 6 to 8 weeks and at
night only for 1 additional week.

Acute Transection of Extensor Tendon

- An open injury of the extensor tendon insertion
requires repair of the tendon.
-Extension of the skin laceration proximally required
to grasp the tendon and mobilize it to its insertion, a
roll suture usually is sufficient .
-The repair can be protected with a transarticular
Kirschner wire.
-The roll suture is removed after approximately 3
weeks, the Kirschner wire is removed at
approximately 4 weeks,
-The finger is splinted for an additional 4 weeks to
protect the repair.
-Progressive motion exercises are commenced and
continued until maximum function has been
achieved.

Roll Stitch
The roll stitch is especially useful for suturing extensor tendons over or near the
metacarpophalangeal joints.

 Use a 4-0 monofilament wire or 4-0 monofilament nylon threaded

on a small, curved needle
Suture through the skin just medial or lateral to the divided
tendon
Through the proximal segment of the tendon near its margin from
superficial to deep, and then through the deep surface of the
distal segment, to emerge on its superficial surface.
Next, pass it proximally and through the opposite margin of the
proximal segment and bring it out through the skin on the
opposite side of the tendon . Be certain that the suture slides
easily in the skin and tendon.
At about 4 weeks the suture can be removed by pulling on one of
its ends.

EXTENSOR INJURIES : Zone I

Mallet finger = baseball finger

Classification :

Type I : closed trauma, loss continuity, small avulsion

fracture +/Type II : Laceration, DIP, loss continuity
Type III : Abrasion, loss of skin, subcutaneous cover,
tendon substance
Type IV :
A. Transepiphyseal plate fracture
B. Hyperflexion injury
C. Hyperextension injury

EXTENSOR INJURIES : Zone I

Treatment of type I Mallet Finger
Plaster cast : DIP slight hyperextension, PIP 60
flexion
Splints : 6 weeks continous splinting, 2 weeks
night splinting
K wire fixation : across DIP joint
External tendon suture
Direct repair

EXTENSOR INJURIES : Zone I

Treatment of type II & III Mallet Finger

EXTENSOR INJURIES : Zone I

Treatment of type IV Mallet Finger
Continous splinting, DIP extension for 3 4
weeks
Operative treatment : fracture fragments
greater than 1/3 articular surface, K wire
fixation, post op splint

EXTENSOR INJURIES : Zone I

Treatment of type IV Mallet Finger

EXTENSOR INJURIES : Zone II

Secondary to laceration or crush injury
Treated by interrupted sutures followed by
static splinting

EXTENSOR INJURIES : Zone III

Boutonniere lesion
Acute flexion avulsion of central slip
Treatment of closed Boutonniere deformity:
Splinting of PIP joint
Transarticular K wire, PIP joint in full extension

EXTENSOR INJURIES : Zone III

Treatment of open Boutonniere deformity

EXTENSOR INJURIES : Zone IV

Usually partial lacerations
Post op : PIP full extension, DIP left free

EXTENSOR INJURIES : Zone V

EXTENSOR INJURIES : Zone VI

Better prognosis than more distal lesions :

Unlikely have associated joint injuries

Less potential for adhesion formation
Greater tendon excursion
Post op : dynamic splinting

EXTENSOR INJURIES : Zone VII

Associated with retinaculum damage
Nonabsorbable sutures

EXTENSOR INJURIES : Zone VIII

Multiple nonabsorbable sutures
Post op : statis immobilization of the wrist in
40 45 extension, MCP in 15 20

POSTOPERATIVE MANAGEMENT