Name of the Procedure:

Tenolysis of Flexor or Extensor Tendon in the Leg and/or Ankle for Multiple Tendons (through separate incision[s])

Summary

Tenolysis is a surgical procedure designed to free a tendon from adhesions that limit its movement. It can be performed on both the flexor and extensor tendons in the leg and ankle, often requiring multiple incisions to address each tendon individually.

Purpose

This procedure aims to restore normal tendon function and alleviate pain and stiffness caused by adhesions. It helps individuals regain mobility and improve their ability to perform everyday activities.

Indications

Tenolysis is indicated for patients experiencing:

• Limited tendon mobility due to adhesions
• Pain and stiffness in the leg or ankle
• Impaired function or difficulty performing daily activities

Patient criteria include those who have not responded to non-surgical treatments and exhibit clear signs of tendon adhesions.

Preparation

• Patients may be instructed to fast for a certain period before the procedure.
• Medication adjustments might be necessary.
• Preoperative imaging studies or electrodiagnostic tests to assess tendon function and adhesion extent.

Procedure Description

1. The patient is administered appropriate anesthesia, either local, regional, or general.
2. An incision is made at the site of the affected tendon(s).
3. The surgeon carefully separates the tendon from surrounding adhesions.
4. Multiple tendons, if involved, are treated through separate incisions.
5. The incisions are then closed with sutures.
6. The area is bandaged and immobilized appropriately.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity and the number of tendons involved.

Setting

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

Personnel

• Orthopedic surgeon or a specialist in hand and foot surgery
• Surgical nurses
• Anesthesiologist or nurse anesthetist

Risks and Complications

Common risks include:

• Infection
• Bleeding
• Nerve injury
• Re-formation of adhesions

Rare complications:

• Prolonged stiffness
• Tendon rupture
• Adverse reactions to anesthesia

Benefits

• Improved range of motion
• Reduced pain and stiffness
• Enhanced functional ability Patients generally begin to notice improvements within a few weeks as they progress through rehabilitation.

Recovery

• Postoperative instructions will include wound care, medication for pain management, and activity modifications.
• Physical therapy is often required to regain full function.
• Recovery time varies but generally spans several weeks to a few months.
• Follow-up appointments will ensure proper healing and monitor for any complications.

Alternatives

• Physical therapy and occupational therapy
• Use of splints or orthotics
• Alternative surgical options like tendon transfer or grafting Each alternative has its own set of benefits and limitations, which should be discussed with the healthcare provider to determine the best course of action.

Patient Experience

During the procedure, patients will be under anesthesia and should not feel pain. Postoperatively, there might be some discomfort and swelling, which can be managed with medication and ice packs. Pain generally decreases within a few days, and physical therapy will help in regaining tendon function and mobility.