What Are the Different Types of Tendon Repair Surgery?
The tendon is composed of longitudinal fiber bundles, which are connected by loose connective tissue between the bundles. Tendon suture is a procedure that repairs and sutures a broken tendon to restore its function. Tendon rupture and defect are common diseases, mostly caused by injuries or lesions. In order to restore the function of the limb, the ruptured or defective tendon must be repaired in time.
Basic Information
- Chinese name
- Tendon suture
- Anesthesia
- Nerve block anesthesia, epidural anesthesia, local anesthesia
- Indication
- Tendon rupture
- Postoperative management
- Avoid infection, external fixation, functional training
Tendon suture anesthesia
- Brachial plexus anesthesia or high continuous epidural anesthesia is usually used for upper limbs; spinal anesthesia or continuous epidural anesthesia is usually used for lower limbs. Local anesthesia can be used for simple operations.
Tendon suture preparation
- 1. Determine whether there is nerve injury or fracture in the tendon rupture site before surgery; prepare various surgical instruments according to the position, type and size of the tendon;
- 2. The edema and inflammation of the limbs and diseased parts, even mild, should be actively treated so that they completely subsided before surgery;
- 3. Locally larger and harder scars should be removed and repaired with skin flaps to ensure good blood flow and soft loose tissue beds around tendons;
- 4. Prior to the suture of the tendon, the joint stiffness that dominates the movement should be treated first, and physical therapy and active and passive exercises should be given to restore a greater degree of activity before surgery can be performed and the effect of tendon suture can be received.
Indications for tendon suture
- Tendon rupture should be repaired.
- 1. The primary suturing of the extensor tendon or flexor tendon and the sheath of the tendon was cut by sharp devices, the pollution was not heavy, the wound was neat, and within 8 hours after the injury. When the deep and shallow tendons in the flexor tendon sheath break at the same time, the superficial tendons can be removed early and the deep tendons can be sutured.
- 2. The secondary suture wound is not infected, but if the patient is late for treatment, the tendon can be sutured about 3 weeks after the injury.
- 3. Late repair If the wound has been infected, it should be repaired 3 months after the wound has healed.
Contraindications for tendon suture
- Open tendon rupture, a primary suture of the tendon at the same time as debridement, but it is not suitable in the following cases: tendon contusion and laceration, severe wound contamination; tendon rupture, combined with significant soft tissue blood flow disorders; in some injuries Injuries during work such as meat processing, fur processing, sewage operation, etc. Although the appearance of the wound is still clean and the tendon stump is relatively neat, it is prone to infection after surgery.
Tendon suture surgery method
- Kessler method
- Kleinert method
- Tsutsuta suture method (Tsuge method)
- Tendon fixation
- Tendon braid suture
- 1. "8" suture method: This method can withstand greater tension and is not easy to tear the tendon. It is suitable for suture flat and wide tendons with equal thickness at both ends. Especially suitable for the tendon of the hand.
- 2. Stainless steel wire pull-out and suture method: stainless steel wire is selected as the suture material to enhance the tensile force, reduce the reaction of the tissue to the suture, prevent the occurrence of adhesion, and is suitable for those with high tension at the broken end.
- 3. Double "ten" suture method: The application range of this method is basically the same as the "8" suture method, which is mainly applicable to tendons with low tension after suture.
- 4. Knitting and suture method: This method is suitable for suture of tendons of different thickness at both ends, or the thickness of both ends is equal, but the tendon with greater tension is required to be sutured. The tendon must have sufficient length, which is suitable for tendon suture outside the tendon sheath. .
- 5. Buttonhole suture method: This method is suitable for suture of one tendon and multiple tendons.
Tendon suture considerations
- 1. When suturing the tendon, the two ends should be tightly closed. Do not leave gaps to avoid poor healing or prolong the healing time. However, it should not be too tight. Too tight will cause tendons to fold and affect its sliding.
- 2. During the whole procedure of tendon surgery, the operation should be gentle. After the tendon is sutured, in order to prevent adhesion, it should be covered with suture around the soft tissue.
- 3. When using stainless steel wire for suture, do not twist the wire into knots, which will affect the suture and smooth extraction after surgery.
Nursing after tendon suture
- 1. Multi-purpose plaster support is fixed for 3 weeks. After 3 weeks, you can remove the plaster fixation, and gradually start to practice joint activities, supplemented by Chinese medicine decoction fumigation or physical therapy.
- 2. Postoperative hematoma and infection should be strictly observed.
- 3. Sutured tendons often have different degrees of adhesion. For mild adhesions, functional exercises and physical therapy are available; for severe localized adhesions, tendon release can also be performed; for severe adhesions and a wider range of Adhesive tendon can be removed about 3 months after operation for tendon transplantation.
- 4. During the fixation period, if the suture of the synaptic tendon is loose or there is a feeling of loss of the extremities, or the fingers or toes cannot be stretched or flexed after the plaster is removed, it means that the suture of the tendon is detached or tendon avulsion occurs. Surgery is required at this time.