Name of the Procedure:

Reconstruction of tendon pulley, each tendon; with tendon or fascial graft (includes obtaining graft)

Summary

This surgical procedure restores the function of a damaged tendon pulley in the fingers by using either a tendon or fascial graft. The pulley helps guide and stabilize the tendon, allowing for smooth finger movements.

Purpose

The purpose of this procedure is to repair damage to the tendon pulleys, which are essential for the proper functioning of finger tendons. This can improve grip strength and hand dexterity, alleviating pain and restoring normal hand function.

Indications

• Trigger finger (stenosing tenosynovitis) that doesn't respond to conservative treatments
• Tendon pulley damage from trauma or injury
• Congenital defects affecting tendon pulley function
• Severe tendon bowstringing causing functional limitations

Preparation

• Patients may need to fast for at least 8 hours before the procedure.
• Adjustments to medications, particularly blood thinners, may be required.
• Pre-operative assessments including blood tests, imaging (e.g., X-rays), and a thorough medical history review.

Procedure Description

1. The patient is administered anesthesia, typically local with sedation or general anesthesia.
2. An incision is made over the affected tendon pulley.
3. The damaged pulley is identified and assessed.
4. A graft is harvested from a tendon or fascia, typically from a different part of the patient's body.
5. The harvested graft is precisely shaped and positioned to reconstruct the damaged pulley.
6. The graft is secured in place, and the tendon is repositioned.
7. The incision is closed with sutures, and the area is bandaged.

Duration

The procedure typically takes 1-2 hours.

Setting

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

Personnel

• Orthopedic hand surgeon or plastic surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist
• Operating room technicians

Risks and Complications

• Infection
• Bleeding or hematoma formation
• Graft rejection or failure
• Scarring or adhesions
• Nerve injury
• Reduced range of motion or stiffness
• Pain or swelling

Benefits

• Restoration of normal finger function
• Reduction in pain and discomfort
• Improved hand strength and dexterity
• Enhanced overall quality of life

Recovery

• The hand is typically immobilized in a splint or cast for several weeks.
• Physical therapy is often recommended to regain motion and strength.
• Full recovery can take several months, with gradual improvement noted over time.
• Follow-up appointments are necessary to monitor the healing progress.

Alternatives

• Non-surgical treatments such as splints, physical therapy, or corticosteroid injections.
• Other surgical options like partial pulley release or other reconstructive techniques.
• Pros and cons: Non-surgical methods might offer temporary relief and carry fewer risks but might not be effective for severe cases. Alternative surgeries might have different risks and benefits depending on specific conditions.

Patient Experience

During the procedure, the patient will not feel pain due to anesthesia. Post-surgery, there may be discomfort or soreness, which can be managed with pain medications and icing. Full recovery involves a period of immobilization followed by physical therapy, and patients should expect some lifestyle adjustments to accommodate healing.