Name of the Procedure:

Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (e.g., no man's land); primary or secondary without free graft, each tendon

Summary

This procedure involves the surgical repair or advancement of a flexor tendon in the hand or wrist, excluding the critical "no man's land" area (zone 2). It's done to restore function to the affected tendon without using a graft from another part of the body.

Purpose

The procedure addresses torn or damaged flexor tendons that are responsible for bending fingers or the wrist. The goal is to restore normal movement and strength to the affected area, reducing pain and improving hand functionality.

Indications

• Severe pain and functional impairment due to a torn or damaged flexor tendon.
• Inability to flex affected fingers or wrist
• Visible deformity or abnormal positioning of the finger or hand.
• Clinical examination and imaging studies confirming tendon injury.
• Patients in good overall health and no contraindications to surgery.

Preparation

• Patients may need to fast for at least 6-8 hours before the procedure.
• Certain medications like blood thinners may need to be adjusted or stopped prior to surgery.
• Pre-operative assessments include physical examination, imaging studies (like MRI or ultrasound), and blood tests.
• The patient should arrange transportation for after the procedure, as driving post-surgery is not recommended.

Procedure Description

1. The patient is positioned comfortably, and the surgical area is cleaned and sterilized.
2. An incision is made near the damaged tendon.
3. The surgeon identifies and isolates the damaged portion of the tendon.
4. The tendon is carefully repaired or advanced using specialized sutures and techniques.
5. The incision is closed with sutures, and the wound is dressed.
   • Tools include surgical instruments like scalpel, forceps, tendon repair kits, and sutures.
   • Local or regional anesthesia is typically used to numb the affected area; general anesthesia may be used in some cases.

Duration

The procedure generally takes about 1-2 hours, depending on the complexity and extent of the tendon damage.

Setting

This procedure is usually performed in a hospital operating room or an outpatient surgical center.

Personnel

• Orthopedic or hand surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist
• Surgical technician

Risks and Complications

• Infection at the surgical site
• Bleeding
• Nerve damage leading to numbness or tingling
• Scarring and stiffness
• Tendon re-rupture or failure to heal properly
• Blood clots

Benefits

• Restoration of normal finger or wrist movement and strength
• Reduction in pain and discomfort
• Improved hand function and quality of life
• Most benefits are realized a few weeks to months post-surgery as the tendon heals.

Recovery

• The patient will be given a splint or brace to immobilize the affected area.
• Pain management with prescribed medications.
• Physical therapy usually starts a few weeks after surgery to restore motion and strength.
• Full recovery can take several months, with gradual return to daily activities and work.
• Follow-up appointments to monitor healing and adjust rehabilitation as needed.

Alternatives

• Non-surgical treatments like physical therapy and splinting.
• Tendon grafting if the primary repair isn't feasible.
• Medications for pain and inflammation.
• Each alternative comes with its own pros and cons. Non-surgical methods may be less invasive but often less effective for complete tears.

Patient Experience

• Patients may feel some pain and discomfort post-surgery, which can be managed with medications.
• Swelling and limited movement are expected initially.
• Frequent follow-ups and adherence to rehabilitation are crucial for a successful outcome.
• Gradual improvement in hand function over several weeks to months.