This is a second case of an actual tendon repair surgery. This patient ruptured (broke) his tendon while playing football. He was grasping firmly and someone forced his finger out, rupturing the FDP tendon.
Note that the fourth finger does not rest in a gently flexed posture. Compare to the first picture on the Tendon Surgery page. Note that the index finger in that case also rests in a bit of extension.
The incision has been made. The pickups (metal forceps in the middle of the picture) are holding the tendon end.
Here the pickups are holding the tendon end. To the right, you can see the A4 and the C3 pullies. For reference, the pullies are shown below:
"A" stands for "annular pulley" (annular = like rings on a tree) and "C" stands for "cruciate pulley" (cruciate = crossed)
Two pieces of suture has been placed in the ruptured end of the tendon and brought out under the A4 pulley. Note that there are four suture ends.
The tendon end has been passed under A4. Two ends of the suture has now been passed under C3 and placed into the distal stump of the ruptured tendon (on the right; one part is looped, so it looks like there are four sutures, but there are only two). The other two ends of the suture are still not yet passed out to the end.
All of the sutures have been placed into the distal stump, and the two knots are seen on the right. The A4 pulley is intact. Only the A2 and the A4 pullies are needed. I had to remove part of C3 to place the sutures. Some strands of C3 are still in place.
Here I am pulling on the tendon with a metal hook (far left, coming in from the side of the photo), proving that the tendon can glide and the finger can fully flex.
Here is the incision closed. I normally close all the incisions with sutures that are completely under the skin. I think it gives a better closure and the patient does not have to worry about suture removal.
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. When back in the office, i also email them these pictures. 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!
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