Name of the Procedure:

Repair or Advancement, Flexor Tendon, in Zone 2 Digital Flexor Tendon Sheath (No Man's Land); Primary, without Free Graft, Each Tendon

Summary

This surgical procedure repairs or advances a damaged flexor tendon within Zone 2 of the digital flexor tendon sheath, often referred to as "No Man's Land." This area is complex due to the intricate anatomy and the importance of the tendons for finger movement.

Purpose

This procedure addresses tears or ruptures in the flexor tendons of the fingers, which are crucial for flexing the digits. The goal is to restore function and mobility to the affected finger, allowing the patient to regain optimal use of their hand.

Indications

• Torn or ruptured flexor tendons in Zone 2
• Loss of finger flexion and grip strength
• Pain or discomfort due to a tendon injury
• Failed previous surgery or non-surgical treatment

Preparation

• Pre-operative instructions may include fasting for several hours before surgery.
• Adjustments to current medications, especially anticoagulants, may be necessary.
• Diagnostic imaging, such as an MRI or ultrasound, to assess the extent of tendon damage.

Procedure Description

1. The patient is administered local or general anesthesia based on the surgeon's assessment.
2. An incision is made over the affected area in Zone 2 of the digit.
3. The injured tendon is identified and carefully repaired or advanced using sutures.
4. Any damaged tissues or adhesions are addressed to ensure smooth tendon gliding.
5. The incision is closed with sutures, and a sterile dressing is applied.
6. The finger may be splinted to protect the repair and promote healing.

Duration

The procedure typically takes 1 to 2 hours, but this may vary depending on the complexity of the injury.

Setting

This surgery is usually performed in a hospital or an outpatient surgical center.

Personnel

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

Risks and Complications

• Infection at the incision site
• Tendon rupture or re-injury
• Stiffness or decreased range of motion
• Scar tissue formation
• Nerve injury
• Need for additional surgery

Benefits

• Restored finger flexion and improved hand function
• Reduced pain and discomfort
• Increased grip strength and dexterity
• Enhanced quality of life by regaining the use of the affected hand

Recovery

• Post-operative care includes keeping the finger immobilized with a splint.
• Physical therapy may begin within a few days to weeks to facilitate tendon gliding.
• Full recovery typically takes several months, during which heavy lifting or strenuous hand activities should be avoided.
• Follow-up appointments to monitor healing and progress.

Alternatives

• Non-surgical treatments like splinting and physical therapy for less severe injuries.
• Secondary repairs or tendon grafts if primary repair is not possible.
• Prosthetic devices or adaptive equipment for severe loss of function.

Patient Experience

• During the procedure, the patient will be under anesthesia and should not feel pain.
• Post-operative discomfort can be managed with prescribed pain medications.
• Swelling and stiffness are common initially but improve with therapy.
• Adherence to rehabilitation protocols is crucial for a successful outcome.