This is an actual tendon repair surgery, for the tendon laceration patient whose hand appears on the Tendon Laceration page. He cut both tendons to his index finger. During the surgery, two core sutures are placed into each tendon, then a superficial fine suture provides a smooth, gliding surface.
The patient was washing a wine glass. It shattered, and a shard of glass went into his palm. He could not flex his index finger.
Note how, at rest, the finger is in a completely straight position. Normally, there is a slight amount of flexion at each of the three joints of each finger, with more flexion in the little finger and progressively less as you move to the index finger. Look at your own hand.
The laceration in the palm is directly over the flexor tendons to the index finger. Amazingly, he did not cut any artery or nerve, even though they are only a few mm away from the tendon.
Two of the tendon ends can be seen between the red markers. On the left, the tendon is the white object. On the right, the tendon is reddish, covered by a layer of synovial tissue. Note that there is no bleeding: all hand surgery is done with a tourniquet, so that there is no bleeding. This allows me to see all the structures of the hand clearly. I also use loupes, which are $1500 magnifiers that are worn like glasses.
The tendon is being repaired with suture (green). A magnified image is shown below.
The needle holder (silver object coming in from bottom left) is grasping the suture's needle (point to right, suture to left). This tendon already has one suture placed; this is the second. Note to the far left is another tendon with two strands of suture coming out of it, waiting to be repaired to its other end, seen to the right bottom, with two sutures coming out of it.
The first tendon has had its two core sutures placed.
Both tendons have been repaired, with both a double core suture and a running surface suture, called an "epitendinous repair", to smooth out the tendon ends and provide for a smooth gliding surface.
This is the dressing after surgery. It is designed to keep the finger flexed, so that there is no stress to the tendon repair.
Here is the patient, a few minutes after surgery. I have a comprehensive pain management protocol, so there is usually no pain in the recovery room, as you can see from this patient's smile. He did not take anything in the 10 days after surgery more than Celebrex and Tylenol.
The patient had an appointment with the Certified Hand Therapist, which was arranged before surgery. I called them from the recovery room, to discuss the strength of the repairs and to determine the post-operative hand therapy. Co-operation with hand therapy is essential for a good outcome, so this is discussed in advance with the patient and the first visit to the therapist is arranged before we even enter the operating room. This teamwork (surgeon, patient, and therapist) is only way to get an optimum recovery, which I think we all agree is very important!
|
Would you like to search the medical library of
the National Library Medicine for scientific papers on this topic?
Just click on
|
 |
Remember the admonition from the Patient Education Links Page: the Internet has a lot of information, much of it incorrect. I have reviewed the sites that I have linked to, and have only linked to sites when I personally know the surgeon who posted it, or am a member of the organization that posted it. However, I may not agree with all that is on that site, and it may have changed since I reviewed it. If any of the information is not consistent with what I have told you, please download the material and bring it in.
|
|