Name of the Procedure:

Repair or advancement of flexor tendon in zone 2 digital flexor tendon sheath (also known as "No Man's Land"), secondary, without free graft, for each tendon.

Summary

This procedure involves surgically repairing or advancing a flexor tendon within the zone 2 area of the digital flexor tendon sheath, commonly called "No Man's Land." This is done without using a free tendon graft and typically follows an initial injury that has not healed properly.

Purpose

The procedure addresses flexor tendon injuries in the fingers that impair movement and function. The goal is to restore the tendon's ability to facilitate normal finger bending, improving hand function and reducing pain.

Indications

• Inability to flex (bend) the finger(s) affected by the tendon injury.
• Persistent pain or dysfunction due to a previously injured flexor tendon.
• Failed primary repair or non-healing of a flexor tendon injury.
• Suitable for patients with good overall health and without severe systemic diseases.

Preparation

• Patients may need to fast for 6-8 hours prior to the procedure if general anesthesia is planned.
• Bacterial cultures or imaging studies like ultrasound or MRI may be required.
• Patient should discuss current medications with their doctor, as some may need to be adjusted or paused.

Procedure Description

1. Anesthesia: The procedure is performed under local, regional, or general anesthesia based on the extent of the injury and patient factors.
2. Incision: A precise incision is made to access the damaged tendon.
3. Tendon Repair: The surgeon meticulously repairs or advances the tendon using specialized suturing techniques, without adding a free graft.
4. Closing: After securing the tendon, the incision site is closed with sutures.
5. Post-op Care: A protective splint or cast is applied to immobilize the finger and promote healing.

Duration

The procedure typically takes around 1-2 hours, depending on the complexity.

Setting

This surgery is performed in a hospital, outpatient clinic, or surgical center, often as an outpatient procedure.

Personnel

• Orthopedic or hand surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist
• Possibly physical therapists for post-operative care

Risks and Complications

• Infection at the incision site
• Tendon rupture or failure to heal properly
• Stiffness or limited range of motion in the affected finger
• Scar tissue formation
• Nerve damage, potentially affecting sensation

Benefits

• Improved range of motion and finger function
• Reduced pain and discomfort
• Ability to perform daily activities more easily
• Benefits may be noticed within a few weeks post-surgery, but full recovery may take several months.

Recovery

• Post-op instructions include keeping the hand elevated and dry, taking prescribed pain medications, and attending follow-up appointments.
• Physical therapy is often recommended to restore strength and flexibility.
• Recovery typically spans 6-12 weeks, with some restrictions on hand use during this time.

Alternatives

• Non-surgical options like physical therapy or splinting
• Primary tendon repair (if not already attempted)
• Tendon graft procedure, where a graft from another tendon is used
• The choice of treatment depends on the specific case and patient preferences, with pros and cons discussed with the healthcare provider.

Patient Experience

• During the procedure, the patient will be under anesthesia and should not feel pain.
• Post-surgery, there might be discomfort, which can be managed with prescribed pain relief.
• Temporary immobility and the need for a splint or cast are expected.
• Gradual improvement in finger movement with adherence to physical therapy and post-op care instructions.