Recent Updates in Reconstruction of Flexor Tendon Injuries in the Hand

Abstract

Human hand is a miraculous tool of the body that serves us extremely well in a multitude of ways, we successfully use our hands to identify objects , communication and extracting a wealth of information about the surrounding objects. A complex system of interconnected joints with a Distinctive groups of muscles and tendons mechanisms and numerous other aiding structures, form a sophisticated biomechanical system that gave humans the ability to perform complicated tasks and develop dexterous professions that require sophisticated hand and finger movement. Tendon surgery is one of the most important topics in hand surgery; its importance to hand function and its rising gain of interest to hand surgeons are well-reflected in the vast number of investigations and publications devoted to this topic. Surprisingly, despite revolutionary changes in the treatment of tendon injuries and disorders. This field still needs more and more effort to raise awareness for the importance of the presence of well-trained hand surgeons teams integrated in different trauma centers. With close knowledge to the basic science, a wealth of research and participation has been accumulated. Our knowledge of tendon biology and biomechanics has increased greatly, technology introduced a number of new research fields such as gene therapy, tissue engineering, stem cell delivery, and gene therapy. In the early half of the last century, Bunnell used the term No man’s Land to describe the region where the flexor tendon passes through the digital sheath (zone 2 for the flexor system). Bunnell advised surgeons to be cautious when repairing the flexor tendon in zone 2 and outlined rigid conditions Since the mid-1980s, the clinical practice of tendon surgery has evolved considerably, and a great number of innovative techniques have emerged. They include a myriad of novel repair techniques, use of new suture materials, novel tendon sheath and pulley treatments, vascularized tendon grafts, and the development of various postoperative rehabilitation. Injuries to the flexor tendons occur in the digits, palm, wrist, or distal and mid-forearm. Repairs of flexor tendons in the digital sheath area are technically demanding. In the tenth century, Avicenna, an Arabian surgeon, was credited with performing the first tendon repair surgery. In Europe, however, Galen teachings resulted in infrequent tendon repair such that teaching at that time (circa 150 AD) involved an intimate relationship between tendons and nerves, so much so that physicians feared severe consequences from damaging or even touching a nerve or a tendon. In England around 1850, Syme reported success with several cases of tendon repair paving the way for modern tendon repair and reconstruction. Functional results after flexor tendon repair in zone 2 have markedly improved over the past three decades. However, a big dilemma of flexor tendon repair in zone 2 remains the challenge between scar formation and risks of rupturing the repairs. Not only repair techniques but also postoperative mobilization require a balance between these two extremes. Primary and delayed primary flexor tendon repairs are indicated in clean-cut tendon injuries with limited damage to the peri-tendinous tissues or a wound that can be converted to a clean-cut wound. Neurovascular injury is not a contraindication to primary repairs. Loss of soft tissue coverage over the tendon or the presence of fractures is a borderline contraindication.