Tendon repairs are some of the most commonly demanded hand surgery procedures. Tendon injuries are very common across all ages. Tendon repairs include flexor tendon and extensor tendon repair.
The treatment of a torn tendon is surgical. They are usually associated with open wounds, cuts or lacerations that must be treated effectively. Ideally the best time is when the injury occurs. The patient should be taken to the operating room. The wounds should be washed out, irrigated with antibiotics and debrided of all foreign bodies and desiccated or non-viable tissue. The tendons must be addressed next.
Tendon lacerations can be partial or complete. In either case tendon repair should be performed by suture re-approximation.
Often times patients will go to the emergency room after a laceration that has among other things severed a tendon. A specialized hand surgeon may not be present or available during the visit to the ER. In this case it is advisable for the ER doctor to wash out the wounds, perform bedside debridement and then close the wound and put the patient on antibiotics. Then the patient should be referred to a hand surgeon for proper operative tendon repair.
Tendon repair should ideally occur within 2-3 weeks from the time of injury. The reason for this is that once severed tendons begin to shrink and after 3 weeks it may not be possible to approximate them effectively.
The traction applied to the tendon repair is important because the severed tendon edges must be repaired in the same tension, as they would be under normal uninjured conditions.
In cases where tendon repair does not occur within a few weeks form the initial injury and hand function is impaired then tendon repair and reconstruction can happen with the use of interposition tendon grafts to bridge the gap.
Therapy following tendon repair involves early passive motion exercises in order to promote healing and also prevent adhesions at the tendon repair-healing site. Adhesions form as a result of all surgery and can prevent the proper excursion of the tendon motion.
Botox in muscles associated with the repaired tendons has been used in order to weaken the muscle strength but not inactivate it. A weaker muscle exerts less traction on the tendon repair site and this can promote tendon healing.