Introduction
Injuries to the flexor and extensor tendons are a major part of the workload of a hand surgeon. In most cases, surgical repair can restore the function of a tendon that would otherwise be permanently lost.
Indications
Any open hand injury where a tendon injury is suspected should be promptly surgically explored in an operating theatre.
Preoperative Instructions
Depending on the circumstances of your injury, you may be treated straight away via the emergency department. If your surgery is done in a more planned manner, tendon repairs are usually treated as day surgery cases. General anaesthetic is the norm, but depending on the specific injury regional or local anaesthetic may be appropriate.
Procedure
The original laceration is usually extended to gain an adequate view of the divided tendon and to protect the nearby nerves and blood vessels. The tendon is repaired with a combination of different suture materials and the tension is checked to ensure normal hand movement.
Postoperative Instructions
The key to good outcomes after tendon repair is hand therapy. After a short period of immobilization after the surgery there is usually a 6 to 8 week rehabilitation program with a combination of protective splinting and range of motion exercises. It is usually 12 weeks before return to heavy manual work or contact sport.
Risks
The major problem after tendon repair is tendon adhesion. Sometimes the scarring resulting from the injury and the surgery limits finger movement despite appropriate hand therapy. This can sometimes result in the need for an additional operation after the tendon has healed to release the scarring.
Treatment Alternatives
Surgery is usually the only way to restore the tendon function. However, in some cases it can be deferred until someone can go through the necessary rehabilitation program. This will usually not yield as good results and prompt surgery would be recommended.