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Hand Surg. 2014;19(2):305-10. doi: 10.1142/S0218810414300022.

Management of flexor tendon injuries - Part 2: current practice in Australia and guidelines for training young surgeons.

Author information

1
Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, University of Sydney, Sydney, Australia.

Abstract

INTRODUCTION:

This study aims to gain a better understanding of current practice for the surgical management and rehabilitation of flexor tendon injuries in Australia, with the intent of establishing common guidelines for training of young surgeons.

METHODS:

A survey was distributed to the membership of the Australian Hand Surgery Society to determine whether a consensus could be obtained for: suture material and gauge; core and epitenon suture techniques; sheath and pulley management; and post-operative protocols for primary flexor tendon repair.

RESULTS:

The predominant materials used for core suture are Ticron™ Suture (Tyco Healthcare Group LP, Norwalk, Connecticut, USA) (34%) and Ethibond™ Polyester Suture (Ethicon, Somerville, New Jersey, USA) (24%). The two core suture configurations commonly used are the Adelaide (45%) and Kessler (32%) repair. The predominant materials used for epitendinous sutures are 6-0 Prolene™ Polypropylene Suture (Ethicon, Somerville, New Jersey, USA) (56%), 5-0 Prolene™ (21%) and 6-0 Ethilon™ Nylon Suture (Ethicon, Somerville, New Jersey, USA) (13%); and the majority (63%) use a running epitendinous technique. The management of critical pulleys is variable, with 89% prepared to perform some release of A2 and A4 pulleys. Rehabilitation protocols vary widely, with 24% of respondents using the same method for all patients, while 76% tailor their approach to each patient. Some component of active motion was used by most.

DISCUSSION:

There exists some consensus on the management of flexor tendon injuries in Australia. However, the management of critical pulleys and methods of post-operative rehabilitation remain varied. For the training of young surgeons, a majority advise a 3-0 gauge braided polyester core suture of four strands, combined with a 6-0 Prolene™ simple running epitendinous suture for increased tendon repair strength and smooth glide. Trainees should attempt to retain the integrity of the A2 and A4 pulleys. Post-operative rehabilitation should include a component of active flexion.

PMID:
24875524
DOI:
10.1142/S0218810414300022
[Indexed for MEDLINE]

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