Injuries of the Flexor Tendons

Abstract

A huge progress has been made these last years in the surgical treatment and rehabilitation of the flexor system. However, a good knowledge of the tendon healing process and some experience are required to limit the risks of tears or secondary adherences.

As always in hand surgery, but even more in tendon surgery, the gesture must be precise and meticulous to avoid tissue trauma, which leads to oedema and adherences, as much as possible.

The goal of this repair is to obtain a strong primary suture, allowing an immediate controlled rehabilitation, which is the only thing that can guarantee a good functional result.

Rehabilitation has to limit the risks of adherences and avoid any rupture of the suture in priority. A badly measured rehabilitation will lead to one of these two complications. There is a wide variety of rehabilitation protocols, depending on the physiotherapy centre. It also depends on the suture (type of suture, number of strands, etc.).

However, the immediate postoperative care and active exercises seem to be used in every centre, as they increase the intrinsic healing of the tendon. These early mobilizations create a healing remodelling, with a longitudinal orientation of the collagen fibres and a faster maturation of the tendinous callus. The mobilized tendons are therefore stronger and more mobile than the ones that are immobilized.