bellyrepaired

PartiallyDividedFlexorTendonInjuries:ShouldTheyBeRepairedorNotShkelzenB.
Duci1HasanR.
Ahmeti21ClinicofPlasticSurgery,UniversityClinicalCenterofKosovo,Prishtina,Kosovo2ClinicofPediatricSurgery,UniversityClinicalCenterofKosovo,Prishtina,KosovoSurgJ2016;2:e89–e90.
AddressforcorrespondenceHasanR.
Ahmeti,PhD,AssociateProfessor,ClinicofPediatricSurgery,UniversityClinicalCenterofKosovo,Prishtina10000,Kosovo(e-mail:hasanahmeti@yahoo.
com).
Flexortendoninjuriesarecommonbecausethetendonslieclosetotheskin.
Therefore,theyareexposedtoinjurieslikelacerationsandcrushinjuries,andoccasionallytheycanruptureattheirboneinsertions.
1Tendoninjuriesarethesecondmostcommonhandinjuriesinorthopedicpatients.
2Thecorrectmanagementofpartiallydividedexortendoninjuriesisstillcontroversial.
Opinionsregardingwhetherpartiallydividedexortendoninjuriesshouldberepairedstillvaryacrosstheliterature.
3Controversyalsoexistsintheliteratureregardingthepropertreatmentofpartialexortendonlacerations.
Wrayetalcreatedconsiderablecontroversybyrecommend-ingthatpartialexortendonlacerationsberepaired.
4,5Severalauthorshavereportedanincreasedriskoftriggering,entrap-ment,orruptureassociatedwithlacerationsofthetendonandhaveadvocatedsurgicalrepairofthoseinjuries.
6–10Ontheotherhand,Bishopetalstudiedacaninemodelanddescribedtherelativeeffectsoftenorrhaphy.
Theyalsode-scribedhealingwhentheexortendonwasnotrepaired.
6Parametersevaluatedafter35-dayhealingperiodincludedexcursion,breakingstrength,energyabsorption,andstiff-ness.
Dataanalysisintheirstudyrevealedstatisticallysigni-cantadverseeffectsonbreakingstrength,stiffness,andenergyabsorptionwhenrepairedbymodiedKesslertech-niquecomparedwiththetendonsthatwerenotrepaired,whichresultedintendonmorphologyclosertonormal.
Similarly,McGeorgeandStilwellstudiedpartiallylacerat-edexortendoninjuriesandcomparedtheresultsofrepairwiththoseofnonrepair,showingbetterresultsintendonsthatwerenotrepaired.
10Theauthorsconcludedthatpartiallylaceratedtendonsshouldnotberepaired.
Also,thelevelofexortendoninjurycarriesaprognosticimplicationbecauseofthedifferentanatomicconstraintstotheexortendonsovertheircoursefromthemusclebellyintheforearmtotheirinsertioninthephalanges.
Verdandevelopedauniformnomenclature(zoneItozoneV)thathasnowbeenacceptedbymosthandsurgeons.
11Manyfactorsareuniquetotendoninjuries,especiallyinzoneII,makingitdifculttorepairthetendonsinthisarea.
Mostinjuriesinthiszonethatlaceratethetendonalsodisruptthenutritionalsystemsofthetendonthatsupportrecovery.
Particularly,damageofthedigitalsheathleadstoleakageofthesynovialuidcontainedwithinit.
Thislossofsynovialuidmaystarvethetendonrepairprocess,be-causenutrientsarenormallyprovidedtothetendonpri-marilyviadiffusionthroughthisuid.
Furthermore,evenifthelossofuidisnotgreat,damageinthesheathcanimpairtendonnutrition,becauseitallowsthepressureoftheuidinthesheathtodissipate.
Thislossofpressurecandeprivethetendonofnutrients,becausethedistributionofthesenutrientsisnormallypropelledbyaprocessofimbibition,inwhichsynovialuidisforcedintotheKeywordsexorlaceratedtendonAbstractThecorrectmanagementofpartiallydividedexortendoninjuriesisstillcontroversial.
Opinionsvaryregardingwhetherpartiallydividedexortendoninjuriesshouldberepaired.
Flexortendoninjuriesarecommonbecausethetendonslieclosetotheskin.
Thetendonsarethereforeexposedtoinjurieslikelacerationsandcrushinjuries,andoccasionallytheycanrupturefromwheretheyarejoinedtothebone.
Tendoninjuriesarethesecondmostcommonhandinjuriesinorthopedicpatients.
receivedFebruary20,2016acceptedafterrevisionAugust10,2016DOIhttp://dx.
doi.
org/10.
1055/s-0036-1593356.
ISSN2378-5128.
Copyright2016byThiemeMedicalPublishers,Inc.
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THIEMEReviewArticlee89intersticesbetweentendonfasciclesduringexionandextensionofthedigit.
12,13Althoughthereweremorecontroversiesamongdifferentauthorsregardingrepairofexortendondigito-rumsupercialisandtheexortendondigitorumprofun-dusinzoneIIinjuryduetothecreationofadhesions,mostauthorsrecommendthatbothtendonsshouldberepaired,withtheexordigitorumsupercialistendonrepairedrst.
14Inbrief,multipleinvestigatorshaveconcludedthatpartiallacerationsinvolving60%ofthetendon'scross-sectionalareashouldnotberepaired.
Thatrecommendationissup-portedbybothinvivoandexvivobiomechanicalstudiesthathavedemonstratedthatnonrepairedpartiallacerationsbearsignicantlygreaterultimateloadsandexhibitgreaterstiff-nessthanrepairedtendons.
6,10,15Therecommendationofthemajorityofauthorsforinju-riesinvolving60%ofthetendoncross-sectionalareaisdebridementofthetendon.
Injuriesinvolving>60%ofthetendonshouldberepairedwithtraditionalcore-suturemeth-odssupplementedwitharunningepitendinoussuture.
14Futureresearchonthetreatmentofthepartiallylacer-atedexortendonsshouldfocusondevelopmentsandunderstandingofsofttissuehealingatthecellular,molec-ular,andgeneticlevelstoenablesurgeonstomodulatethehealingprocesstoimprovethestrengthoftherepairsitewhileatthesametimereducingadhesionafterinjuryandsurgicalrepair.
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