Loss of movement due to paralysis can sometimes be restored using a piece
of tendon/ muscle unit whose function can be spared.
Pre-requites for a successful tendon transfer
- Stability of proximal joints
- Prior correction of any fixed deformity
- At least grade 4/5 power
- Direct line of pull
- Firm point of fixation - preferably bone
Joint mobility is maintained pre-operatively by physiotherapy.
There can be no fixed contractures. Postoperatively the joint is splinted
for at least six weeks.
Methods of attaching
tendon to bone
The best way of attaching tendon to bone is to drill a tunnel through
the bone and loop the tendon back onto itself and then suture the tendon
Suture of tendons
for hand flexor tendons
Severed tendons are best sutured primarily. In some situations such
as Zone 2 (under the flexor pulleys in the palm) special suture
techniques such as the Kessler suture allow a less bulky suture line.
Classification of nerve damage
- Neurotmesis (complete division) Usually seen in open wounds
e.g. knife wound. The nerve is completely severed.
- Axonotmesis (incomplete division) Only the axoms are divided.
Usually in traction and closed injuries. Clinically it in indistinguishable
from axomomesis, but complete recovery is likely
- Neurapraxia (physiological interruption) The axoms are
intact and the only injury is degradation of the axon sheaths. Motor
loss is usually seen and sensory loss is less common.
| Nerve Suture. Fascicles are matched
and epineuruim sutured with 6/0 or finer material
Timing of repair
- Immediate exploration and suture of open injuries
- Closed nerve
injuries can be treated conservatively (i.e. splints and physiotherapy)
and observed for signs of recovery. Repair is undertaken at 6 weeks
to a few months later if necessary.
Signs of nerve recovery
- Return of sensory or motor function
- Progressive Tinnel
sign ( point of percussion tenderness over nerve course)
- Speed of growth about 6mm per week. The distance to the target organ
is thus critical. The higher the lesion, the worse the prognosis.
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