Name of the Procedure:

Repair, Extensor Tendon, Hand, Primary or Secondary; Without Free Graft, Each Tendon
Common Name: Extensor Tendon Repair
Medical Term: Tendonoplasty

Summary

Extensor tendon repair is a surgical procedure aimed at fixing damaged or severed extensor tendons in the hand. These tendons are crucial for straightening the fingers and thumb. The procedure can be primary (immediate) or secondary (delayed) and does not involve using a graft from another part of the body.

Purpose

The purpose of the extensor tendon repair is to restore normal function and movement in the fingers and hand affected by tendon damage. This procedure aims to reestablish the tendon's ability to properly extend the fingers, which is essential for tasks that require hand dexterity.

Indications

• Severe lacerations or cuts to the hand
• Rupture or severe damage to the extensor tendons
• Deformity in finger movement
• Loss of hand function due to tendon injury

Patient Criteria:

• Patients with acute or chronic tendon injuries
• Patients who exhibit difficulty or inability to extend their fingers

Preparation

• Fasting: Patients may need to fast for a certain period before surgery.
• Medication Adjustments: Adjustments or discontinuation of certain medications may be necessary.
• Diagnostic Tests: Imaging studies like X-rays or MRI scans to assess the extent of tendon damage.

Procedure Description

1. Anesthesia: The procedure typically involves local or general anesthesia.
2. Incision: A small incision is made over the damaged tendon area.
3. Tendon Repair: The surgeon stitches the ends of the tendon together or repairs any tears using specialized sutures.
4. Closure: The incision is closed with sutures or surgical glue.
5. Bandaging: The hand is bandaged and sometimes splinted to immobilize the repair site.

Tools and Equipment:

• Sutures and surgical needles
• Scalpels and surgical scissors
• Sterile bandages and dressings

Duration

The procedure typically takes about 30 minutes to an hour per tendon.

Setting

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

Personnel

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

Risks and Complications

• Infection at the incision site
• Tendon rupture or failure to heal properly
• Stiffness or decreased range of motion
• Nerve damage
• Scarring or formation of adhesions

Benefits

• Restored ability to extend fingers and thumb
• Improved hand function and dexterity
• Relief of pain and discomfort associated with tendon injury

Recovery

• Post-Procedure Care: Keep the hand elevated, use ice packs to reduce swelling, and take prescribed pain medications.
• Physical Therapy: Early mobilization and physical therapy may be recommended.
• Recovery Time: Full recovery may take several weeks to months, depending on the extent of the injury and repair.
• Restrictions: Avoid heavy lifting, strenuous activities, and follow-up appointments for suture removal and progress monitoring.

Alternatives

• Non-Surgical Management: Splinting and occupational therapy for minor tendon injuries.
• Other Surgical Options: Using free grafts for extensive or complex tendon injuries.

Pros and Cons:

• Pros of Non-Surgical Management: Less invasive, no surgical risks.
• Cons: May not fully restore tendon function for severe injuries.

Patient Experience

During the procedure, if local anesthesia is used, patients might feel pressure but not pain. Post-operatively, there can be some discomfort, managed with pain medication. Swelling and stiffness are common initially, but physical therapy helps alleviate these symptoms ensuring a smoother recovery process.