Name of the Procedure:

Tenotomy, flexor, palm, open, each tendon
Common name(s): Flexor tendon release surgery

Summary

A flexor tenotomy is a surgical procedure where the tendons in the palm, responsible for bending the fingers, are cut to relieve tension and improve movement. It is performed using an open surgical technique.

Purpose

This procedure addresses flexor tendon tightness or contractures that restrict hand and finger movements. The goal is to restore function and reduce pain in the affected fingers, improving the overall quality of life for patients.

Indications

• Dupuytren's contracture
• Trigger finger
• Severe palm tendon tightness due to injury or scarring
• Patients experiencing significant hand function impairment due to tendon issues

Preparation

• Patients may be asked to fast for several hours before the procedure.
• Medication adjustments might be necessary, particularly blood thinners.
• Pre-operative imaging tests (e.g., X-rays, MRI) and physical examinations to assess tendon status.

Procedure Description

1. The patient is positioned and local or general anesthesia is administered.
2. A small incision is made in the palm over the affected tendon.
3. The surgeon identifies and carefully cuts the targeted flexor tendon(s).
4. The incision is closed with sutures, and the area is bandaged.
5. The hand is often placed in a splint to support healing.

Duration

The procedure typically takes about 30 minutes to an hour, depending on the number of tendons involved.

Setting

The surgery is usually performed in an outpatient setting, such as an ambulatory surgical center or hospital.

Personnel

• Orthopedic surgeon or hand surgeon
• Surgical nurse
• Anesthesiologist (if general anesthesia is used)
• Surgical technician

Risks and Complications

• Infection at the incision site
• Nerve damage resulting in numbness or tingling
• Scarring
• Failure to achieve desired improvements in tendon flexibility
• Potential need for additional surgeries

Benefits

• Enhanced finger mobility and function
• Relief from chronic pain associated with tendon tightness
• Improved ability to perform daily activities

Recovery

• Post-operative care includes keeping the hand elevated to reduce swelling.
• Patients may need to take prescribed pain medication.
• Physical therapy is often recommended to restore strength and flexibility.
• Full recovery typically takes several weeks to a few months, with follow-up appointments to monitor progress.

Alternatives

• Non-surgical options like physical therapy, splinting, or corticosteroid injections
• Minimally invasive techniques such as needle aponeurotomy for Dupuytren's contracture
• Pros: Non-surgical options are less invasive and have shorter recovery times.
• Cons: They may not be as effective for severe cases requiring surgical intervention.

Patient Experience

During the procedure, local or general anesthesia ensures the patient feels no pain. Post-operatively, the patient may experience some discomfort, swelling, and tenderness in the hand, which can be managed with medications. Physical therapy can aid comfort and speed up recovery, and most patients regain significant hand function within a few months.