BOOK
Tendon Surgery of the Hand E-Book
Jin Bo Tang | Peter C. Amadio | Jean Claude Guimberteau | James Chang
(2012)
Additional Information
Book Details
Abstract
Get the best results from the latest procedures with Tendon Surgery of the Hand, the only reference that offers comprehensive coverage of this complex and challenging area. World-renowned experts guide you through all of the newest techniques and technologies, equipping you to restore optimal function in your patients. It's your one-stop source for mastering today's best approaches to treating tendon injuries and disorders of the hand.
- Consult this title on your favorite e-reader with intuitive search tools and adjustable font sizes. Elsevier eBooks provide instant portable access to your entire library, no matter what device you're using or where you're located.
- Successfully implement hot new repair techniques involving new suture materials, tendon sheath and pulley treatments, vascularized tendon grafts, and recent postoperative rehabilitation methods.
- Improve your primary flexor tendon repair and rehabilitation treatment planning based on surgical and post-surgical care principles that clearly describe successful global methods and protocols.
- Benefit from the collective knowledge and experience of an international group of surgeons, investigators, and therapists who offer unique and insightful techniques and advice.
- See how to perform key techniques with exclusive operative videos online.
- Access the complete contents online at expertconsult.com.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Expert Consult page | ifc_i | ||
| TENDON SURGERY OF THE HAND | i | ||
| Copyright page | ii | ||
| Dedication | iii | ||
| Preface | iv | ||
| Contributors | vi | ||
| Table of Contents | x | ||
| Section 1 Basic Science | 1 | ||
| Chapter 1 Anatomy of the Tendon Systems in the Hand | 3 | ||
| Outline | 3 | ||
| Flexor Retinaculum | 3 | ||
| Extensor Retinaculum | 4 | ||
| Flexor Tendons in the Hand | 4 | ||
| Flexor Tendon Sheaths | 5 | ||
| Structure of the Sheath at Wrist and Palm | 5 | ||
| Structure of the Digital Flexor Sheath | 5 | ||
| Vincula Tendinea | 6 | ||
| The Pulley System | 8 | ||
| Intrinsic Muscles: the Lumbricals and Interossei | 9 | ||
| Chiasma Tendinum of Camper | 10 | ||
| Extensor Tendons at the Wrist | 10 | ||
| Variations in Extensor Tendons to the Fingers | 11 | ||
| Extensor Mechanism of the Fingers | 12 | ||
| Tendons in the Thumb | 13 | ||
| References | 14 | ||
| Chapter 2 Tendon Nutrition and Healing | 16 | ||
| Outline | 16 | ||
| Tendon Nutrition | 16 | ||
| Vascular Sources | 16 | ||
| Synovial Fluid | 16 | ||
| Tendon Healing | 16 | ||
| Biology of Tendon Healing | 16 | ||
| Effect of Physical Factors | 17 | ||
| Motion | 17 | ||
| Loading | 17 | ||
| Effect of Friction on the Results of Tendon Repair | 17 | ||
| Impact on Postoperative Management: Concept of the “Safe Zone” | 18 | ||
| Pharmacological Manipulation of Tendon Healing | 19 | ||
| Augmentation of Intrinsic Tendon Healing | 19 | ||
| Stem Cells | 19 | ||
| Cytokines | 19 | ||
| References | 20 | ||
| Chapter 3 Tendon Friction, Lubrication, and Biomechanics of Motion | 24 | ||
| Outline | 24 | ||
| Tendon Friction | 24 | ||
| Tendon Friction in Physiological Conditions | 24 | ||
| Tendon Friction in Pathological Conditions | 25 | ||
| Tendon Friction in Different Tendon Surroundings | 26 | ||
| Tendon Lubrication | 27 | ||
| Intrasynovial Tendon Lubrication Mechanism | 27 | ||
| Extrasynovial Tendon Lubrication | 28 | ||
| Biomechanics of Tendon Motion | 29 | ||
| Mechanical Properties of Tendon | 29 | ||
| Biomechanics of Tendon Motion | 30 | ||
| References | 32 | ||
| Chapter 4 Biomechanics of Core and Peripheral Tendon Repairs | 35 | ||
| Outline | 35 | ||
| Essential Mechanical Requirements of a Surgical Repair | 35 | ||
| Historical Reviews | 36 | ||
| Current Tendon Repair Techniques | 36 | ||
| Types of Tendon–Suture Junctions and Their Strength | 37 | ||
| Strengths of Core Sutures | 38 | ||
| Strength of Peripheral Sutures | 40 | ||
| Factors Affecting the Strengths of Tendon Repairs—Summary | 41 | ||
| Important Factor 1—Tension of Suture Repair Affects Gap Formation | 41 | ||
| Important Factor 2—Sufficient Suture Purchase and Lock (Grasp) Size are Essential | 42 | ||
| Important Factor 3—Strength Does Not Increase during Early Tendon Healing | 42 | ||
| Important Factor 4—Strength Decreases when the Finger Flexes | 43 | ||
| Important Factor 5—Softening of Traumatized Tendon Parts Decreases Holding Power | 43 | ||
| Two Ways to Increase Strength— More Suture Strands and Larger Suture Calibers | 44 | ||
| Test Setup and Measurements of Tendon Repair Biomechanics | 45 | ||
| Considerations in the Design and Use of Repair Methods | 46 | ||
| References | 47 | ||
| Chapter 5 Biology and Biomechanics of the Tendon–Bone Insertion | 49 | ||
| Outline | 49 | ||
| Structure and Function of the Tendon–bone Insertion | 49 | ||
| Morphology of the Tendon Enthesis (tendon–bone Insertion Site) | 49 | ||
| Gradations in Biomechanical, Compositional, and Structural Properties Along the Tendon–Bone Insertion Site | 50 | ||
| Composition and Microstructure of the Insertion Site Is Optimized to Minimize Stress Concentrations | 50 | ||
| Development of the Tendon–bone Insertion Site | 51 | ||
| Role of Biological Factors | 51 | ||
| Role of Mechanical Factors | 52 | ||
| Tendon–bone Repair | 53 | ||
| Basic Science of Tendon–Bone Healing | 53 | ||
| Bone Loss Following Tendon or Ligament Injury | 54 | ||
| Rehabilitation Based Treatments | 54 | ||
| Biologically Based Treatments | 55 | ||
| References | 56 | ||
| Chapter 6 Gene Therapy for Tendon Healing | 59 | ||
| Outline | 59 | ||
| Innate Weakness in Intrinsic Tendon Healing and “no-Gain” Period in Strength | 60 | ||
| Overall Concepts and Methods of Gene Therapy | 60 | ||
| Biological Methods to Enhance Tendon Healing | 61 | ||
| Gene Therapy Approaches—the First Step: Choosing Genes and Delivery Methods | 61 | ||
| The Second Step: Testing the Effects of Growth Factor Gene Therapy in Vitro | 62 | ||
| The Third Step: Assessment of Effects of Growth Factor Gene Therapy in Vivo | 64 | ||
| Gene Therapy Associated With Micro-Rna Regulation in Tendon Healing | 66 | ||
| Future Perspectives | 68 | ||
| References | 68 | ||
| Chapter 7 Tendon Tissue Engineering and Bioactive Suture Repair | 71 | ||
| Outline | 71 | ||
| Tissue Engineering | 71 | ||
| Tendon Biology | 71 | ||
| Structure and Anatomy | 72 | ||
| Cells | 72 | ||
| Tendon Healing | 72 | ||
| Extrinsic Versus Intrinsic Healing | 72 | ||
| Tendon Tissue Engineering | 73 | ||
| Cells | 73 | ||
| Cell Type and Cell Source | 73 | ||
| Site of Seeding (In Vivo versus In Vitro) | 74 | ||
| Autogenous versus Allogeneic Cell Seeding | 74 | ||
| Scaffolds | 74 | ||
| Biologic Scaffolds | 74 | ||
| Synthetic Scaffolds | 75 | ||
| Acellularized Scaffolds | 75 | ||
| Growth Factors | 76 | ||
| Mechanical Manipulation | 76 | ||
| Bioactive Suture | 76 | ||
| Conclusion | 77 | ||
| References | 77 | ||
| Section 2 Primary Flexor Tendon Surgery | 79 | ||
| Chapter 8 Indications for Primary Flexor Tendon Repair | 81 | ||
| Outline | 81 | ||
| Anatomical Divisions | 81 | ||
| Etiologies and Evaluation of Tendon Injuries | 81 | ||
| Timing of Tendon Repair | 83 | ||
| Indications | 84 | ||
| Borderline Indications | 85 | ||
| Absolute Contraindications | 87 | ||
| References | 87 | ||
| Chapter 9 Treatment of the Flexor Tendon Sheath and Pulleys | 88 | ||
| Outline | 88 | ||
| Anatomy | 88 | ||
| Function | 89 | ||
| Historical Review | 89 | ||
| Investigations | 89 | ||
| Investigation of Sheath Treatment—Excision, Repair and Reconstruction | 89 | ||
| Investigation of the Anatomy of the A2 Pulley and Clinical Partial A2 Pulley Release | 92 | ||
| Investigations of the Effects of Integrity of the A2 Pulley in Chicken Models and Partial A2 and A4 Pulley Releases in Clinical Cases | 93 | ||
| Treatment Guidelines | 93 | ||
| Indications and Operative Methods | 93 | ||
| Direct Closure | 93 | ||
| Excision | 94 | ||
| Sheath Reconstruction by Grafts | 94 | ||
| Venting of the Major Pulleys (such as the A2 and A4) | 94 | ||
| Considerations | 96 | ||
| References | 97 | ||
| Chapter 10 Venting of the Major Pulleys | 98 | ||
| Outline | 98 | ||
| History | 98 | ||
| Author’s Clinical Research | 99 | ||
| Distal Bowstringing | 101 | ||
| The Significance of Pulley Venting | 102 | ||
| References | 102 | ||
| Chapter 11 The Omega “Ω” Flexor Pulley Plasty | 104 | ||
| Outline | 104 | ||
| Methods and Outcomes | 104 | ||
| Anatomy of the Fibrous Digital Sheath Tunnel | 104 | ||
| Operative Techniques | 105 | ||
| Omega Plasty of the A4 Pulley | 105 | ||
| Omega Plasty of the A2 Pulley | 107 | ||
| Postoperative Care | 107 | ||
| Outcomes | 107 | ||
| Discussion | 107 | ||
| Summary | 109 | ||
| References | 109 | ||
| Chapter 12 Tendon Sheath and Pulley Enlargement | 111 | ||
| Outline | 111 | ||
| Surgical Technique | 112 | ||
| Operative Techniques | 112 | ||
| Clinical Outcomes | 112 | ||
| Biomechanical Studies | 113 | ||
| Discussion | 113 | ||
| References | 114 | ||
| Chapter 13 Clinical Primary Flexor Tendon Repair and Rehabilitation | 116 | ||
| A The Bern Experience | 116 | ||
| Outline | 116 | ||
| Methods and Outcomes | 116 | ||
| Patients | 116 | ||
| Operative Techniques | 119 | ||
| Postoperative Care | 119 | ||
| The Staged Rehabilitation Group: “Stop and Go” | 119 | ||
| Red: Passive Flexion, Active Extension. | 119 | ||
| Yellow: Place and Hold | 121 | ||
| Green: Early Active | 121 | ||
| Outcomes | 121 | ||
| Complications | 122 | ||
| Lim/Tsai Group | 122 | ||
| Kessler Group | 122 | ||
| Discussion | 122 | ||
| References | 123 | ||
| B The Chelmsford Experience | 125 | ||
| Outline | 125 | ||
| History | 125 | ||
| The St. Andrew’s Unit | 125 | ||
| The Problems of Primary Flexor Tendon Repair | 125 | ||
| Early Active Mobilization | 126 | ||
| Passive Mobilization | 126 | ||
| St. Andrew’s Early Results—fingers | 126 | ||
| The 5% Rupture Rate | 127 | ||
| Etiology of Ruptures | 127 | ||
| The Splinted Wrist Position | 128 | ||
| Rupture Re-Repair | 128 | ||
| Venting the Pulleys | 129 | ||
| Stronger Repairs | 129 | ||
| Zone 2 as a Black Box | 129 | ||
| The Flexor Pollicis Longus Model | 130 | ||
| Stronger Sutures—dilemmas | 130 | ||
| Economic Factors | 131 | ||
| Conclusion | 131 | ||
| References | 131 | ||
| C The Mayo Clinic Experience | 133 | ||
| Outline | 133 | ||
| Indications | 133 | ||
| Operative Techniques | 133 | ||
| Postoperative Care | 136 | ||
| Summary | 136 | ||
| References | 136 | ||
| D The Nantong Experience | 138 | ||
| Outline | 138 | ||
| Clinical Methods | 138 | ||
| Anesthesia and Skin Incisions | 138 | ||
| Zone 2 Flexor Tendon Repairs | 138 | ||
| Incisions in the Sheath and Pulleys | 138 | ||
| Tendon Repair Techniques | 140 | ||
| Treatment of the FDS Tendon | 142 | ||
| Treatment of the FDP and FDS Tendons in the Palm (Zone 3) | 143 | ||
| Treatment of the FDP Tendon in Zone 1 | 143 | ||
| Treatment of the FPL Tendon | 144 | ||
| Flexor Tendon Repairs in Children | 146 | ||
| Postoperative Rehabilitation | 147 | ||
| The First Period (Surgery to Weeks Postsurgery) | 148 | ||
| The Second Period ( to 5 Weeks Postsurgery) | 148 | ||
| Outcomes | 149 | ||
| Discussion | 149 | ||
| References | 152 | ||
| E The Singapore Experience | 153 | ||
| Outline | 153 | ||
| Methods and Outcomes | 154 | ||
| Operative Techniques | 154 | ||
| Postoperative Care | 154 | ||
| Outcomes | 155 | ||
| Summary | 156 | ||
| Acknowledgments | 156 | ||
| References | 156 | ||
| F The Stanford Experience | 157 | ||
| Outline | 157 | ||
| Operative Technique | 158 | ||
| Postoperative Rehabilitation | 159 | ||
| Authors’ Preferred Postoperative Rehabilitation Program | 159 | ||
| Weeks 0 to 3 | 159 | ||
| Weeks 4 to 5 | 159 | ||
| Week 6 | 159 | ||
| Week 8 | 160 | ||
| Summary | 160 | ||
| References | 160 | ||
| G The Australian Experience | 161 | ||
| Outline | 161 | ||
| Recent Advances, 2000–2010 | 163 | ||
| Current Practice in Flexor Tendon Repair and Rehabilitation | 165 | ||
| Authors’ Preferred Approach | 166 | ||
| Summary | 167 | ||
| References | 167 | ||
| H The Wellington Experience | 168 | ||
| Outline | 168 | ||
| The Audits | 168 | ||
| Discussion | 168 | ||
| Benefits of Serial Audit | 168 | ||
| The Change to a Four-Strand Repair | 169 | ||
| Fiberwire | 169 | ||
| The Nature of Hand Injuries and Their Management in New Zealand | 169 | ||
| Targets | 169 | ||
| Conclusion | 170 | ||
| References | 170 | ||
| Chapter 14 Partial Tendon Lacerations | 171 | ||
| Outline | 171 | ||
| Diagnosis and Physical Examination | 171 | ||
| Physiology of Tendon Healing | 172 | ||
| Biomechanical Properties of Partial Tendon Injury | 172 | ||
| Tensile Strength and Cross-Sectional Area | 172 | ||
| Tensile Strength and Repair | 173 | ||
| Early Mobilization and Tendon Remodeling | 173 | ||
| Tendon Gliding and Resistance | 173 | ||
| Tendon Nutrition and Adhesion Formation | 174 | ||
| Surgical Repair of Partial Tendon Injuries | 174 | ||
| Surgical Repair or Nonrepair | 174 | ||
| Peripheral Suture or Core Suture Repair | 174 | ||
| Trimming of the Partially Lacerated Tendons | 175 | ||
| Postoperative Rehabilitation | 175 | ||
| Complications | 175 | ||
| Summary | 176 | ||
| References | 177 | ||
| Chapter 15 Flexor Tendon Injuries in Children | 179 | ||
| Outline | 179 | ||
| Incidence | 179 | ||
| Diagnosis | 179 | ||
| Treatment | 182 | ||
| Adjuncts to Surgery | 182 | ||
| Rehabilitation | 182 | ||
| Outcomes | 182 | ||
| Complications | 183 | ||
| Flexor Tendon Grafting In Children | 183 | ||
| Current Treatment Recommendations | 184 | ||
| References | 185 | ||
| Chapter 16 Primary Repair of the Flexor Pollicis Longus Tendon | 186 | ||
| Outline | 186 | ||
| The Problem of Flexor Pollicis Longus Retraction | 186 | ||
| The Avascular Zone 2 Site of The FPL | 186 | ||
| Treatment of FPL Division Before 1989 | 186 | ||
| Treatment of FPL Division 1989–1999 | 187 | ||
| FPL Repair With 8% Ruptures: St. Andrew’s 1994–1999 | 187 | ||
| FPL Repair with No Ruptures: St. Andrew’s 1999–2004 | 187 | ||
| FPL Repair with No Ruptures: Elsewhere | 188 | ||
| Simpler FPL Repair with No Ruptures: St. Andrew’s 2004–2009 | 188 | ||
| FPL Repair with No Ruptures: Other Simple Alternatives | 190 | ||
| Management of the Retracted FPL | 190 | ||
| The Success of FPL Rupture Re-Repair | 191 | ||
| References | 191 | ||
| Chapter 17 Treatment of Flexor Tendon Injuries at or Proximal to the Wrist | 194 | ||
| A Zone 5 Flexor Tendon Repairs | 194 | ||
| Outline | 194 | ||
| Clinical Features | 194 | ||
| The Flexor Digitorum Superficialis Tendons: To Repair or Not | 195 | ||
| References | 196 | ||
| B Methods and Outcomes of Zone 5 Flexor Tendon Repairs | 198 | ||
| Outline | 198 | ||
| Patients and Outcomes | 199 | ||
| Patients | 199 | ||
| Surgical Methods | 199 | ||
| Postoperative Care | 199 | ||
| Outcomes | 200 | ||
| Summary | 200 | ||
| References | 202 | ||
| Chapter 18 Flexor Tendon Repairs with Novel Sutures and Devices | 203 | ||
| A Mantero’s Technique for Tendon Repair | 203 | ||
| Outline | 203 | ||
| Indications | 203 | ||
| Surgical Techniques | 203 | ||
| Postoperative Care | 205 | ||
| Outcomes | 206 | ||
| Discussion | 206 | ||
| References | 207 | ||
| B Teno Fix for Tendon Repair | 208 | ||
| Outline | 208 | ||
| A Biomechanical Study | 208 | ||
| Clinical Techniques and Outcomes | 209 | ||
| Patients | 209 | ||
| Inclusion Criteria | 209 | ||
| Exclusion Criteria | 209 | ||
| Operative Techniques | 210 | ||
| Postoperative Care | 210 | ||
| Outcomes | 211 | ||
| Discussion | 211 | ||
| Advantages | 211 | ||
| Disadvantages | 211 | ||
| Acknowledgments | 212 | ||
| References | 213 | ||
| Chapter 19 Treatment of Rupture of Primary Flexor Tendon Repairs | 214 | ||
| Outline | 214 | ||
| The Suture | 214 | ||
| The Patient | 214 | ||
| The Sheath | 214 | ||
| Timing of Occurence of the Rupture | 215 | ||
| Immediate Re-Repair of Ruptures | 215 | ||
| The Results of Rupture Re-Repair | 215 | ||
| Rupture of the Re-Repair | 217 | ||
| Possible Modifications of the Re-Repair | 217 | ||
| The Little Finger | 217 | ||
| Conclusion | 218 | ||
| References | 218 | ||
| Chapter 20 Closed Avulsion or Rupture of Flexor Tendons | 219 | ||
| A Traumatic Avulsion of Flexor Tendons | 219 | ||
| Outline | 219 | ||
| Background | 219 | ||
| Mechanism of Injury | 219 | ||
| Classification | 220 | ||
| Diagnosis | 221 | ||
| Treatment | 222 | ||
| Postoperative Care | 224 | ||
| Outcomes | 224 | ||
| Our Personal Experience | 225 | ||
| Summary | 226 | ||
| References | 226 | ||
| B Tendon Rupture After Fractures or Carpal Disorders | 228 | ||
| Outline | 228 | ||
| Methods and Outcomes | 228 | ||
| Patients | 228 | ||
| Operative Techniques | 229 | ||
| Postoperative Care | 229 | ||
| Outcomes | 229 | ||
| Illustrative Case | 229 | ||
| Discussion | 229 | ||
| References | 232 | ||
| C Rupture of the Pulleys | 233 | ||
| Outline | 233 | ||
| Methods and Outcomes | 233 | ||
| Patients | 233 | ||
| Operative Techniques | 234 | ||
| Postoperative Care | 235 | ||
| Evaluations | 235 | ||
| Results | 235 | ||
| Discussion | 236 | ||
| References | 238 | ||
| Chapter 21 The Evolution of End-to-End Surgical Tendon Repairs | 239 | ||
| Outline | 239 | ||
| Early Repairs and Surgical Strategy | 239 | ||
| Pathology of Tendon Healing | 240 | ||
| Further Development of Surgical Repair Technique | 241 | ||
| Relation of Postsurgical Mobilization Methods to Surgical Repair Technique | 244 | ||
| Summary | 244 | ||
| References | 244 | ||
| Chapter 22 Outcomes of Flexor Tendon Repairs and Methods of Evaluation | 246 | ||
| Outline | 246 | ||
| Outcomes Over the Past 20 Years | 246 | ||
| Major Reports and Important Information | 248 | ||
| Methods of Evaluations | 250 | ||
| Factors Affecting Outcomes | 252 | ||
| Adhesion Formation | 252 | ||
| Repair Rupture | 253 | ||
| Joint Stiffness | 253 | ||
| Extent of Injuries | 254 | ||
| Surgical Skill | 254 | ||
| Development of Comprehensive, Universally Acceptable Criteria | 254 | ||
| Considerations Relating to Outcomes | 255 | ||
| Repair of the Flexor Tendons in the Little Fingers | 255 | ||
| Report Levels of Expertise of Physicians in Clinical Studies | 255 | ||
| References | 257 | ||
| Section 3 Secondary Flexor Tendon Surgery | 259 | ||
| Chapter 23 Tenolysis | 261 | ||
| Outline | 261 | ||
| Indications | 261 | ||
| Timing of Surgery | 261 | ||
| Surgical Technique | 262 | ||
| Rehabilitation | 263 | ||
| Results | 264 | ||
| References | 264 | ||
| Chapter 24 Single-Stage Free Tendon Grafting for Flexor Tendon Injury in Fingers | 266 | ||
| Outline | 266 | ||
| Indications | 266 | ||
| Operative Methods | 267 | ||
| Injuries to Both FDP and FDS Tendons | 267 | ||
| Incision | 267 | ||
| Dissection of the Flexor Tendons | 267 | ||
| Graft | 267 | ||
| Placement of the Graft | 267 | ||
| Sequence of Attachment of the Graft Ends | 267 | ||
| Distal End Attachment | 267 | ||
| Proximal Juncture Suture | 269 | ||
| Graft Tensioning | 270 | ||
| Postoperative Care | 270 | ||
| FDP Tendon Disruption with FDS Tendon Intact | 270 | ||
| Outcomes and Complications—prognosis Factors | 271 | ||
| Outcomes | 271 | ||
| Complications | 272 | ||
| Prognosis Factors | 272 | ||
| Summary | 272 | ||
| References | 273 | ||
| Chapter 25 A Historical Perspective on Flexor Tendon Reconstruction and Surgical Procedures | 274 | ||
| Outline | 274 | ||
| Development of Tendon Reconstruction | 274 | ||
| Surgical Procedures | 275 | ||
| Single-Stage Reconstruction | 275 | ||
| Two-Stage Reconstruction | 276 | ||
| References | 278 | ||
| Chapter 26 Experience With Secondary Flexor Tendon Repairs | 279 | ||
| Outline | 279 | ||
| One-Stage Graft | 279 | ||
| Indications | 279 | ||
| Methods | 280 | ||
| Results | 281 | ||
| Two-Stage Graft | 281 | ||
| Indications | 281 | ||
| Method | 282 | ||
| Results | 282 | ||
| Secondary Repair in the Future | 282 | ||
| References | 283 | ||
| Chapter 27 Secondary Reconstruction of the Flexor Pollicis Longus Tendon | 285 | ||
| Outline | 285 | ||
| Primary Repair of Flexor Pollicis Longus by Preference | 285 | ||
| Primary Grafting of Zone 3 and 4 Injuries | 285 | ||
| Techniques to Extend Primary Repair | 286 | ||
| No FPL Repair | 289 | ||
| The Ideal of Interphalangeal Motion | 289 | ||
| Tendon Grafting—The FPL Muscle | 290 | ||
| Tendon Grafting—Bridge Grafts | 290 | ||
| Tendon Grafting—Wrist–to–Distal Phalanx Grafts | 291 | ||
| Tendon Grafting—Distal and Proximal Attachment | 291 | ||
| Tendon Grafting—The Thenar Tunnel | 291 | ||
| Tendon Grafting—The Tension of Setting in the Graft | 291 | ||
| Tendon Transfer | 292 | ||
| Two-Stage Tendon Grafting | 293 | ||
| Tendon Grafting—Rehabilitation | 295 | ||
| Outcomes and Prognosis | 295 | ||
| Conclusion | 295 | ||
| References | 295 | ||
| Chapter 28 Staged Tendon Grafts and Soft Tissue Coverage | 297 | ||
| Outline | 297 | ||
| The Pseudo-Sheath | 298 | ||
| Choice between Single-Stage and Two-Stage Grafting | 298 | ||
| The Clinical Principles of Two-Stage Tendon Grafting | 300 | ||
| Detail of the First Stage | 300 | ||
| Correction of Skin Deficiencies at the First Stage | 301 | ||
| Correction of Pulley Deficiencies at the First Stage | 304 | ||
| Correction of Joint Deficiencies at the First Stage | 304 | ||
| Details of the Second Stage | 305 | ||
| Outcomes and Prognosis | 305 | ||
| References | 306 | ||
| Chapter 29 Two-Stage Reconstruction with the Modified Paneva-Holevich Technique | 307 | ||
| Outline | 307 | ||
| Indications | 307 | ||
| Operative Technique | 308 | ||
| Stage 1 | 308 | ||
| Stage 2 | 308 | ||
| Postoperative Care | 310 | ||
| Stage 1 | 310 | ||
| Stage 2 | 310 | ||
| Outcomes | 310 | ||
| Complications | 310 | ||
| Discussion | 312 | ||
| References | 312 | ||
| Chapter 30 Outcomes of the Modified Paneva-Holevich Procedures and Early Postoperative Mobilization | 314 | ||
| Outline | 314 | ||
| Surgical Technique | 315 | ||
| Stage 1 | 315 | ||
| Stage 2 | 316 | ||
| Early Mobilization | 318 | ||
| Our Protocol | 318 | ||
| Personal Experience and Outcomes | 319 | ||
| Choice of Procedure | 320 | ||
| References | 321 | ||
| Chapter 31 Vascularized Tendon Transfers for Reconstruction | 323 | ||
| A Tendon Vascularity and Gliding, Island and Free Vascularized Transfers | 323 | ||
| Outline | 323 | ||
| Anatomical Studies and Surgical Basis | 324 | ||
| Microvideo Observations of Tendon Structures in Zones 3, 4, and 5 | 324 | ||
| Basic Principles for Our Methods of Tendon Reconstruction | 326 | ||
| Anatomical Features of the Ulnar Artery–Based Pedicle Flap | 327 | ||
| Operative Procedures | 327 | ||
| Vascularized FDS Tendon Graft Based on the Ulnar Artery: Essential Procedures | 327 | ||
| FDS Tendon Transfer to Reconstruct the FDP Tendon With an Intact FDS in Another Finger | 329 | ||
| Combined Island FDS Tendon and Palmaris Longus Tendon Transfer for Tendon and Pulley Reconstruction | 329 | ||
| Composite Flexor Tendon and Skin Flap Transfer | 330 | ||
| Results and Discussion | 332 | ||
| Group 1 | 333 | ||
| Group 2 | 333 | ||
| Group 3 | 333 | ||
| Future Challenges: Procedures Using Other Graft Sources | 336 | ||
| Summary | 338 | ||
| References | 338 | ||
| B Physiotherapy After Vascularized Tendon Transfers | 340 | ||
| Outline | 340 | ||
| Preoperative Physiotherapy | 340 | ||
| Physiotherapy after Surgery | 340 | ||
| Timing | 340 | ||
| Three Phases of Physiotherapy After Surgery | 340 | ||
| Splinting and Joint Positions | 340 | ||
| Methods of Physiotherapy | 341 | ||
| Late Therapy of Extension Deficits | 342 | ||
| Additional Methods | 343 | ||
| References | 343 | ||
| Section 4 Extensor Tendon Repair and Reconstruction | 345 | ||
| Chapter 32 Extensor Tendon Injuries—Primary Management | 347 | ||
| Outline | 347 | ||
| Zone 1—DIP Joint | 347 | ||
| Zone 2—Middle Phalanx | 349 | ||
| Zone 3—PIP Joint | 349 | ||
| Zone 4—Proximal Phalanx | 351 | ||
| Zone 5—MCP Joint | 351 | ||
| Zone 6—Dorsum of the Hand | 352 | ||
| Zones 7, 8, and 9—Wrist, Distal, and Proximal Forearm | 352 | ||
| Summary | 353 | ||
| References | 353 | ||
| Chapter 33 Sagittal Band Injuries—Primary and Secondary Management | 355 | ||
| Outline | 355 | ||
| Anatomy and Biomechanics | 355 | ||
| Causes | 357 | ||
| Classification | 357 | ||
| Diagnosis | 357 | ||
| Differential Diagnosis | 357 | ||
| Treatment Methods | 358 | ||
| Immobilization | 359 | ||
| Surgical Options | 359 | ||
| Injuries to the Thumb | 361 | ||
| References | 362 | ||
| Chapter 34 Tendon Transfers for Extensor Tendon Reconstruction | 364 | ||
| Outline | 364 | ||
| Methods of Treatment | 366 | ||
| Traumatic Injury of EPL | 366 | ||
| Systemic Disease | 366 | ||
| Radial Nerve Dysfunction | 367 | ||
| Restoration of Wrist Extension | 367 | ||
| Restoration of Thumb Extension | 367 | ||
| Restoration of Digit Extension | 368 | ||
| Treatment Alternatives | 369 | ||
| Rehabilitation | 369 | ||
| Summary | 370 | ||
| References | 370 | ||
| Chapter 35 Soft Tissue Coverage for Extensor Tendon Reconstruction | 371 | ||
| Outline | 371 | ||
| Evaluation and Treatment | 371 | ||
| Wound Débridement | 371 | ||
| Timing of Reconstruction | 372 | ||
| Soft Tissue Coverage and Reconstruction | 372 | ||
| Intrinsic Flaps | 372 | ||
| Turnover and Distally Based Adipofascial Flap | 373 | ||
| Reverse Cross-Finger Flap | 373 | ||
| Metacarpal Artery Island Flaps | 373 | ||
| First Dorsal Metacarpal Artery Flap | 373 | ||
| Second Dorsal Metacarpal Artery Flap | 375 | ||
| Perforator-Based DMA Flap | 376 | ||
| Thumb Dorsal Radial Artery Flap | 377 | ||
| Local Flaps | 377 | ||
| Radial Forearm Flap | 378 | ||
| Posterior Interosseous Artery Flap | 378 | ||
| Becker Flap (Ulnar Artery Dorsal Perforator Flap) | 378 | ||
| Free Flaps | 378 | ||
| Lateral Arm Flap | 379 | ||
| Scapula/Parascapular Flap | 379 | ||
| Anterolateral Thigh (ALT) Flap | 379 | ||
| Secondary Procedures | 380 | ||
| SUMMARY | 380 | ||
| References | 382 | ||
| Chapter 36 Treatment of Boutonnière and Swan-Neck Deformities | 383 | ||
| Outline | 383 | ||
| Post-Traumatic Deformity | 383 | ||
| Post-Traumatic Boutonnière Deformity | 383 | ||
| Post-Traumatic Swan-Neck Deformity | 384 | ||
| Rheumatoid Deformity | 384 | ||
| Rheumatoid Boutonnière Deformity of the Fingers | 384 | ||
| Rheumatoid Swan-Neck Deformity of the Fingers | 385 | ||
| Rheumatoid Thumb Deformity | 385 | ||
| Methods of Treatment | 385 | ||
| Post-Traumatic Boutonnière Deformity | 385 | ||
| Nonoperative Management | 385 | ||
| Operative Management | 386 | ||
| Post-Traumatic Swan-Neck Deformity | 386 | ||
| Nonoperative Management | 386 | ||
| Section 5 Rehabilitation of Tendon Surgery | 403 | ||
| Chapter 38 State of the Art Flexor Tendon Rehabilitation | 405 | ||
| Outline | 405 | ||
| Immobilization | 405 | ||
| Controlled Early Mobilization | 406 | ||
| Early Passive Mobilization | 406 | ||
| Early Active Mobilization | 407 | ||
| Patient Selection | 409 | ||
| Controlling Flexion Force | 409 | ||
| Initiating Active Mobilization | 410 | ||
| Fundamental Concepts and Techniques of Evaluation and Treatment | 410 | ||
| Questions and Issues | 412 | ||
| Summary | 413 | ||
| References | 413 | ||
| Chapter 39 Customizing Flexor Rehabilitation Based on Zone or Type of Injury | 415 | ||
| Outline | 415 | ||
| Customizing a Regimen | 415 | ||
| Extent of Injury | 415 | ||
| Mechanism of Injury | 415 | ||
| Number and Type of Structures Damaged | 416 | ||
| Injuries to the Skin | 416 | ||
| Injuries to Bone and Joint | 416 | ||
| Injuries to Nerve | 417 | ||
| Vascularity of Injured Structures | 417 | ||
| Triggering of the Repaired Tendon Against the Pulley | 417 | ||
| Type of Tendon Injury | 417 | ||
| Complete or Partial Injuries | 417 | ||
| Flexor Pollicis Longus (FPL) Injury | 417 | ||
| Other Factors | 417 | ||
| Length of Time From Injury to Repair | 417 | ||
| The Type and Quality of the Repair | 418 | ||
| Patient Characteristics and Compliance | 418 | ||
| Age | 418 | ||
| Zone of Injury | 419 | ||
| Zone 1 | 419 | ||
| Zone 2 | 421 | ||
| Zone 3 | 422 | ||
| Zone 4 | 423 | ||
| Zone 5 | 424 | ||
| Selecting a Regimen Following Re-Repair of Ruptures of the Surgically Repaired Flexor Tendon | 424 | ||
| Summary | 425 | ||
| Acknowledgments | 425 | ||
| References | 425 | ||
| Chapter 40 State of the Art of Extensor Tendon Rehabilitation | 427 | ||
| Outline | 427 | ||
| General Guidelines FOR Care after Extensor Repairs | 428 | ||
| The Initiation of Therapy: Timing | 428 | ||
| Patient Referral Information | 428 | ||
| Record Keeping | 429 | ||
| Rehabilitation Methods in Each Zone: Finger Extensors | 429 | ||
| Zones 1 and 2 (Mallet Finger) | 429 | ||
| First Phase (6 to 8 Weeks): Therapy During Splinting Phase | 429 | ||
| Second Phase (6/8 to 10 Weeks): Initial Exercises Without Splint | 430 | ||
| Third Phase (10 to 12 Weeks): Increase Loading | 430 | ||
| Zone 3: Central Slip Lesion (Boutonnière Deformity) | 430 | ||
| Zone 4: Proximal Phalanx | 432 | ||
| Zones 5 and 6: MCP Joint and Dorsum of the Hand | 432 | ||
| Zone 7: Extensor Retinaculum at the Wrist | 434 | ||
| Zone 8: Forearm | 434 | ||
| Rehabilitation Methods in Each Zone: Thumb Extensors | 434 | ||
| Zone T1 | 434 | ||
| Zone T2 | 434 | ||
| Zones T3 to 5 | 435 | ||
| Clinical Evidence and Outcomes | 436 | ||
| Considerations | 437 | ||
| Acknowledgments | 437 | ||
| References | 437 | ||
| Appendix 1 Therapy Protocols After Extensor Tendon Repairs: St Andrew’s Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK | 438.e1 | ||
| Extensor Tendon Repairs of The Fingers | 438.e1 | ||
| Appendix 2 Therapy Protocols After Extensor Tendon Repair of the Thumb: St Andrew’s Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK | 438.e3 | ||
| Appendix 3 Therapy Protocols After Extensor Tendon Repairs of Fingers: Mid Essex Hospital Services, St Andrew’s Centre-Hand Therapy, Essex, UK | 438.e5 | ||
| Appendix 4 The Manchester Regimen for Postoperative Rehabilitation After Finger Extensor Tendon Repairs, Manchester, UK | 438.e8 | ||
| Appendix 5 Protocols of Exercise After Repair of Extensor Tendon Injuries, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China | 438.e11 | ||
| Appendix 6 Extensor Tendon Rehabilitation Program, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China | 438.e12 | ||
| Appendix 7 Therapy Protocols After Extensor Tendon Repair, Springfield, Mass, USA | 438.e13 | ||
| References | 438.e14 | ||
| Appendix 8 Protocols of Sydney Hand Therapy & Rehabilitation Centre, Sydney, Australia | 438.e15 | ||
| Appendix 9 Therapy Protocols from Royal Free Hampstead NHS Trust, London, UK | 438.e16 | ||
| Section 6 Current Status and Future | 439 | ||
| Chapter 41 Current Status and Future | 441 | ||
| A Current Status and Future of Flexor Tendon Surgery | 441 | ||
| Current Status of Flexor Tendon Surgery | 441 | ||
| The Future of Flexor Tendon Surgery | 441 | ||
| B Current Status and Future | 442 | ||
| C Future of Tendon Surgery of the Hand | 443 | ||
| Online-Only Chapters | e1 | ||
| Chapter 42 Chemical Modification of Tendon Gliding Surface | e1 | ||
| Tendon Lubricants | e1 | ||
| Chemical Surface Modification of Tendon in Vitro | e1 | ||
| Extrasynovial Autograft | e2 | ||
| Intrasynovial Allograft | e5 | ||
| Flexor Tendon Primary Repair | e6 | ||
| Evaluation of Chemical Modification in Animal Models | e6 | ||
| cd-HA–Gelatin: Extrasynovial Tendon Autograft | e7 | ||
| cd-HA–Gelatin: Intrasynovial Tendon Allograft | e7 | ||
| cd-HA–Gelatin/Lubricin: Tendon Repair | e8 | ||
| Summary | e8 | ||
| References | e9 | ||
| Chapter 43 Tendon Gliding: | e11 | ||
| Outline | e11 | ||
| Materials and Methods | e11 | ||
| In Vitro Study of the Paratenon | e11 | ||
| In Vivo Study of Digital Zones 3, 4, and 5 by Microanatomical Video Endoscopic Observation | e11 | ||
| Results | e12 | ||
| In Vivo Observations | e12 | ||
| Macroscopic Observations | e12 | ||
| Ten-Fold Microscopic Examination | e12 | ||
| At 25-Fold Magnification | e14 | ||
| In Vitro Observations | e20 | ||
| Discussion | e20 | ||
| Efficient Dynamic Behavior | e21 | ||
| A Global System | e23 | ||
| Anatomical Features | e23 | ||
| Conclusion | e23 | ||
| References | e25 | ||
| Chapter 44 Molecular Biology of Tendon Healing | e26 | ||
| Two Mechanisms of Intrasynovial Tendon Healing | e26 | ||
| Molecular Biology of Tendon Healing | e27 | ||
| Roles of Individual Growth Factors | e27 | ||
| Roles of Growth Factors and Cytokines In Vivo | e28 | ||
| Extracellular Matrix | e28 | ||
| Intracellular Signal Pathways | e29 | ||
| Tenocyte Apoptosis During Tendon Healing | e29 | ||
| Future for Tendon Healing Biology Investigation and Application | e32 | ||
| References | e32 | ||
| Chapter 45 Molecular Methods to Prevent Adhesion Formation | e34 | ||
| Outline | e34 | ||
| Clinical Significance | e34 | ||
| Pathophysiology | e34 | ||
| Treatment | e35 | ||
| Quantification of Tendon Adhesions | e35 | ||
| Conventional Pharmacological Treatment | e35 | ||
| Biomaterials to Prevent Adhesion Formation | e35 | ||
| Motion | e35 | ||
| Prevention of Adhesions in Tendon Grafting | e36 | ||
| Cytokines | e37 | ||
| Platelet-Derived Growth Factor and Fibroblast Growth Factor | e37 | ||
| Insulin-Like Growth Factor | e37 | ||
| Transforming Growth Factor-β | e37 | ||
| Vascular Endothelial Growth Factor | e38 | ||
| Epidermal Growth Factor | e38 | ||
| Gene Silencing | e38 | ||
| Stem Cells | e38 | ||
| Gene Therapy | e39 | ||
| Conclusions | e40 | ||
| References | e40 | ||
| Chapter 46 Tendon Repairs in Replantation Surgery | e42 | ||
| Surgeries and Tendon Repairs | e42 | ||
| Digital Replantation | e42 | ||
| Surgery | e42 | ||
| Postoperative Care | e42 | ||
| Outcomes | e42 | ||
| Secondary Tenolysis | e44 | ||
| Palm Replantation | e45 | ||
| Surgery | e45 | ||
| Postoperative Care | e45 | ||
| Outcomes | e45 | ||
| Tenolysis | e46 | ||
| Foream Replantation | e46 | ||
| Surgery | e46 | ||
| Postoperative Care | e46 | ||
| Outcomes | e46 | ||
| Tenolysis | e47 | ||
| Functional Evaluation | e47 | ||
| References | e47 | ||
| Appendix | 446 | ||
| Symposium Discussion 1 | 446 | ||
| Symposium of Flexor Tendon Injury, The 10th Congress of International Federation of Societies for Surgery of the Hand (IFSSH) March 12, 2007 The Sydney Convention Center, Sydney, Australia (Figure 1) | 446 | ||
| Symposium Discussion 2 | 447 | ||
| Symposium of Flexor Tendon and Carpal Disorders, The Pre-Congress of The 11th Congress of International Federation of Societies for Surgery of the Hand (IFSSH) October 28, 2010 Affiliated Hospital of Nantong University, Jiangsu, China (Figure 2) | 447 | ||
| A Postscript About Progression of Thought on Primary Tendon Repair | 450 | ||
| Index | 452 | ||
| A | 452 | ||
| B | 453 | ||
| C | 453 | ||
| D | 454 | ||
| E | 454 | ||
| F | 455 | ||
| G | 457 | ||
| H | 458 | ||
| I | 458 | ||
| J | 458 | ||
| K | 458 | ||
| L | 459 | ||
| M | 459 | ||
| N | 460 | ||
| O | 460 | ||
| P | 460 | ||
| Q | 462 | ||
| R | 462 | ||
| S | 463 | ||
| T | 465 | ||
| U | 466 | ||
| V | 466 | ||
| W | 467 | ||
| Y | 467 | ||
| Z | 467 |