Digital flexor tendon sheath trochlear reconstruction

Tendon injury can be accompanied by damage to the important annular thickening of the bone fiber sheath (especially A2 and A4 blocks); or in the early surgical treatment, such as primary surgical repair or subsequent tendon release, the pulley may also be damaged. . During the reconstruction process (including tendon release, stage 1 and staged tendon graft reconstruction), reconstruction will usually fail if efforts are not made to rebuild the pulley. When there is no pulley, the direction of the tendon to the end point will change, the restraining effect of the support band will be destroyed, the proximal interphalangeal joint will be flexed and contracted, the subcutaneous bowstring bulge can be seen in the palm, and the sliding range of the tendon is lost. If a finger loses the effect of the A2 and A4 tackles, there will be no satisfactory function after the tendon is released, and the reconstruction of the tendon graft is futile. The indication for reconstruction of the A2 and A4 tackles is that the residual trochlear system after the tendon release does not function effectively or as part of the reconstruction of the first and second stage tendon grafts. The injured finger should have the following conditions: the fracture and joint damage have healed, the nerve vascular bundle damage is very light or has gradually recovered, the soft tissue is well covered and the scar is scarce. Treatment of diseases: flexor tendon injury Indication It is suitable for the flexor tendon release of the affected finger. In the operation, the sheath tube and the gondola are not present. 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. 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.

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