flexor tendon suture

It is suitable for the proximal volar injury of the left index finger of the patient, and the shallow and deep flexor tendon is broken in the II area. Tendon ruptures and defects are common diseases, mostly caused by injuries or lesions. In order to restore the function of the limbs, fingers and toes, the broken or defective tendons must be repaired in time. However, almost all repaired tendons form different degrees of adhesion and joint activity disorder with surrounding tissues, which is closely related to local pathological conditions, surgical technique, suture material, and correct postoperative treatment, and must be taken seriously. Treatment of diseases: hand extensor tendon injury hand flexor tendon injury Indication 1. Acute or old tendon injury and fracture or defect. 2. Open injury tendon rupture, within 8 to 12 hours after injury, the pollution is not heavy, debridement thoroughly, with complete healthy skin coverage, suture the tendon in one stage. Otherwise, it should be postponed or the wound should be repaired after the wound is completely healed. 3. Tendons that need to be cut or partially removed due to tumors or other lesions should be repaired in one stage. Contraindications 1. The infection after the local injury has not been eliminated. 2. Injury refers to the passive flexion and extension of each joint. Preoperative preparation 1. Edema and inflammation of the limbs and wards, even if mild, should be actively treated, so that it completely disappears after 2 to 3 months of surgery. 2. Local large and hard scars should be removed first and the flaps should be repaired to ensure a good blood supply and a soft loose tissue bed around the tendons. 3. Before the tendon is sutured, the joint stiffness of the dominant tendon should be treated first, and the physical therapy and active and passive exercise should be given to restore the greater activity, so that the effect of the tendon suture can be operated and received. 4. The suture material should be selected from the varieties with small reaction, large pulling force and smooth surface. Generally, soft stainless steel wire with a diameter of 0.25 to 0.30 mm is preferred, and is mostly used for drawing steel wire stitching. Surgical procedure Bunnell buried suture method () Applicable to the diameter of the two ends of the tendon. Position, incision According to the location of the suture tendon, the limbs are required to be stable and suitable for surgery. The incision should be slightly longer. 2. Tendon near the end of the suture First use a hemostat to clamp the tendon of the tendon and tighten it. Take a 30cm long silk thread and wear a slender straight needle at both ends. The needle is traversed through the tendon at a distance of 1.5 cm from the broken end, and the two sides are drawn to be equal in length, and then the needle is inserted next to the needle point, and the oblique end is crossed and symmetrically passed through the tendon, so that the needle is crossed 2 to 3 times. Finally, pierced 3mm proximal to the hemostat. Followed by the sharp knife along the proximal side of the hemostat to cut the tendon, flip the hemostatic forceps to reveal the section, the same as the upper needle, the symmetry of the two sides of the sacral section, remove the tendon stump, tighten the suture. 3. Tendon long-end suture In the same method, first use the hemostat to clamp the broken end, cut the tendon along the inner part of the forceps, turn the hemostatic forceps to expose the section, adjust the axis of the tendon to coincide with the proximal end, and select the position corresponding to the near-section suture point in the far section. The oblique cross-into-needle is drawn at a distance of 3 mm from the cross-section, and the oblique cross-symmetric cross-stitching is performed 2 to 3 times. One needle is traversed to the other side of the needle, and the broken end is cut. 4. Tighten the suture, fit the tendon Pull a suture first, hold the distal end tendon with the other hand, and straighten the suture to eliminate slack in the suture. Pull the other suture again and tighten it so that the tendon sections are in close contact (9). 5. Ligation of sutures The two wires that are adjacent to each other are ligated to cause the knot to sink into the sputum surface. The knot is the weakness of the stitching and should be trapped in the jaw and subject to the lowest tension. 6. Suture the skin and skin. Bunnell wire extraction suture Mainly used for suturing of tendon rupture with greater tension. 3. Position, incision Buried with Bunnell. 2. Tendon near the end of the suture Buried with Bunnell. Only through a 15cm long wire at the corner of the first needle crossing the line, twist the number of turns and turn it through the triangle needle, and take it out from the nearby skin. After the tendon is healed, the wire for suturing the tendon is taken out. 3. Tendon long-end suture The steel wire drawn from the near section of the tendon passes through the corresponding point of the far section and passes through the axis of the crucible in parallel for 2 cm, and then passes through the shallow sides of the crucible. 4. Button fixing The needle thread of the sewed tendon is taken out from the skin of the distal end in the direction of the suture, passes through the smear of the multi-layer gauze pad and the button, and the wire is tightened, so that the proximal end is moved to the distal end, and the section is closely Then, press the button in the reverse direction and tighten the wire to fix it. The needles of the aponeurosis were sutured with a thin thread. 5. Stitching The skin and skin are sutured by layer. Double cross stitching This method is simple to operate, saves time, and is often used for limb amputation, broken hand replantation, or when the condition needs to end the operation as soon as possible. Position, incision Buried with Bunnell. 2. Suture tendon The silk thread is firstly sutured from the shallow surface perpendicularly at a distance of about 0.5 to 1 cm from the proximal tendon, and the line is crossed over the section, and the lateral transverse position at the equivalent distance of the distal tendon is sutured; the lateral traverse of the proximal tendon is reversed. Suture, and then the vertical penetration of the deep side of the distal iliac crest, from the shallow side, the 2 line in the sputum cross. 3. Tightening the joint Gradually tighten the thread so that the section is tightly aligned, the thread is ligated, and the knot is caught in the raft. 4. Stitching Sewing by layer Fish mouth stitching This method is applicable to the difference in the diameter of the broken ends on both sides of the tendon. Position, incision Buried with Bunnell. 2. trimming The rough cut ends are V-shaped and cut into a fish mouth shape, and the depth is about 0.5 cm. Sew a pull line at the end of the fine cut. 3. Through the tendon First, use a sharp-edged knife tip to slant through the center of the bottom of the rough V-port. The tip of the file is pierced by the back of the file. The tip of the blade is clamped with the mosquito cutter, and the V-port is inserted as the blade exits, and the tunnel is expanded to form a fine fit. , pull the fine traction line and pull out the tunnel. At the distance of 0.5cm from the tunnel entrance, another tunnel is traversed and rough, and the fine raft is pulled again. 4. Stitching and fixing After tightening the fine raft to the tension required, suspend the two needles in the middle of the two tunnels to fix the two scorpions, cut the exposed fine scorpion stump outside the rough sputum, insert it into the rough sputum, and suture the aponeurosis to maintain the surface. smooth. Finally, the upper and lower pieces of the fish mouth are sewn on the fine raft. 5. Stitching The subcutaneous tissue and skin are sutured by layer. complication Suppurative infection, infected wounds have pain, redness, tenderness, purulent secretions, etc., body temperature can be increased and neutrophils can be increased. Closed wounds may also be associated with various infections, such as post-injury aspiration, airway endocrine retention, and atelectasis secondary lung infections.