TREATMENT OF LATE TENDON INJURİES

The origin and ending extensions of our muscles that attach to the bones are called "tendons". Tendons that allow us to make fists in our hands and close our hands by bending our fingers are called "flexor tendons", and tendons that allow us to open and straighten the fingers are called "extensor tendons". Especially in injuries caused by sharp instruments, these tendons are cut frequently. The ideal treatment is to bring the cut tendon ends together and repair them as soon as possible. However, due to various reasons (financial impossibility, lack of a hand surgery center in the region, failure to achieve success in the first surgery...) the surgery that should be performed in the first few days may be delayed.

Although delayed, the first thing to try for repair is end-to-end tendon repair. But this is not possible for most tendon lacerations a month or more after the injury. It is necessary to complete the missing part that cannot reach the end with another tendon of suitable length. In this case, a two-session surgery is required, especially in the area from the fingertip to the middle of the palm. Since the flexor tendons pass under some bridge-like structures (pulleys) in this region and are in close proximity to other tendons, the possibility of adhesion to these structures after surgery and the development of various movement restrictions as a result is very strong. In the first session of the repair, a silicone tendon prosthesis is placed from the fingertip to the wrist. The task of the prosthesis used in this session is to create a foreign body reaction tissue around it. This prosthesis is kept in place until the second session, which will be held 3-4 months later. When the silicone prosthesis is removed, the reaction it promotes around it creates an empty tube that will cut off the connection with the environment. After this prosthesis is removed in the second session, a tendon whose deficiency will not cause loss of a function is taken and placed in this tube, and sutured to the intact ends of the injured tendon on the fingertip and wrist. Since the newly placed tendon piece will be placed inside the tube formed by the reaction around it after the silicone is removed, possible environmental adhesions are avoided. The palmaris longus (one of the wrist flexor tendons) or the plantaris tendon (one of the tendons that bend the ankle towards the sole) are most commonly used as a tendon graft. Since there are several tendons that undertake the same function, taking these tendons to be used for other purposes does not cause any deficiency. At the end of the surgery, a splint is applied to prevent damage by stretching the repaired areas in the early period, and certain movements are restricted for 3-4 weeks.

In areas where the probability of adhesions is much less after the surgery, a single session tendon graft can also be taken into consideration. Alternative surgical procedures such as fixation of the most distal joint (distal interphalangeal joint arthrodesis) in cases with delayed injury in the area where the extensor tendon adheres to the fingertip. Tendon transfer from one of the index finger extensors (EIP) can be applied in delayed cases of injury to the thumb extensor tendon (EPL).

Physiotherapy is very important after both early and late tendon surgery. Success will be determined by the patient's motivation and compliance with physiotherapy.