Handchir Mikrochir Plast Chir 2021; 53(05): 475-481
DOI: 10.1055/a-1560-3346
Originalarbeit

The Effect of early active Movement following Repair of Extensor Tendons in Zone IV using three different suture Techniques – A cadaveric Study

Auswirkungen der früh-aktiven Nachbehandlung nach Versorgung von Strecksehnendurchtrennungen in Zone IV unter Verwendung dreier verschiedener Nahttechniken: eine Leichenstudie
Samir Ilgaroglu Zeynalov
1   Özel Afiyet Hospital Department of Orthopaedics and Traumatology
,
Abdulveli Ismailoglu
2   Acibadem University Division of Medical Sciences Department of Anatomy
,
Ural Verimli
3   Marmara University School of Medicine Department of Anatomy
,
Anar Alakbarov
4   Medipol University Pendik Hospital Department of Orthopaedics and Trauma Department
,
Eren Cansü
5   Marmara University School of Medicine Department of Orthopaedics and Traumatology
› Author Affiliations

Abstract

Purpose The aim of this study was to investigate the effects of early active movement on the area repaired with three different suture techniques used in extensor tendon injuries in zone IV.

Materials and Methods A total of nine cadaver’s 35 extensor tendons from 9 intact upper extremities were used in this study. The proximal and distal borders of the extensor tendons in zone IV were marked. The distance between the proximal and distal border was measured with a 0.5 mm precision tape measure and the mid-point was marked. Intertendinous connections were dissected and loop sutures were prepared for each extensor digitorum. Afterwards, force was applied to each digit along the tendon axis from the loops inserted into the extensor tendons, to measure the extensor forces required to extend the MCP joints to 0˚ with a hand scale. The flexor tendons of the digits were dissected at zone III, and loop sutures were prepared individually for the tendons to enable independent flexion for each digit. The force required to fully flex the digits was measured with a hand scale. The extensor tendons were incised transversely and repaired at the mid-point in zone IV with three different suture techniques (double Kessler, double figure of eight, running interlocking horizontal mattress (RIHM)). The extenxor tendon lengths in zone IV were re-measured for all digits after suturing. The predetermined forces required for full flexion and extension of the digits were applied to the repaired digits. After force was applied 20 times to each tendon, the gap formation was checked. Totally 200 flexion and 200 extension movements were applied to each finger with the help of a hand-held scale. Formation of 2-mm gap was failure criteria. At the end of the movements the extent of the gaps was recorded. In the absence of insufficiency at the repair site, 50 additional flexion and extension movements with double the previously recorded forces were applied to the tendons.

Results There was a significant shortening of the extensor tendons after repair independent from the used suture technique. No significant gap formation was detected in all three suture techniques.

Conclusion All three suturing techniques are reliable for early active movements following the zone IV extensor tendon repairs. Therefore, surgeons can choose one of those three suture techniques to repair extensor tendon injuries in zone IV.

Zusammenfassung

Ziel Diese Studie untersucht an Leichenpräparaten die Auswirkungen der früh-aktiven Nachbehandlung von Strecksehnenverletzungen der Finger in Zone IV unter Verwendung dreier verschiedener Nahttechniken.

Material und Methoden Die Untersuchung erfolgte an 35 Extensor-digitorum(ED)-Sehnen an 9 intakten Leichenarmen. Distaler und proximaler Rand der Strecksehnen sowie deren Mitte in Zone IV wurden markiert und die Länge der Strecksehnen in Zone IV gemessen. Nach Durchtrennung der Connexus intertendinei wurden die Strecksehnen mit einer Naht armiert und die Kraft gemessen, die erforderlich war, um eine Streckung der Fingergrundgelenke von 0° zu erzielen. Die Beugesehnen wurden in Zone III freipräpariert, mit einer Naht armiert und anschließend die Kraft gemessen, die es bedurfte, um eine volle Beugung des Fingers zu bewerkstelligen. Die ED-Sehnen wurden mittig in Zone IV durchtrennt und mittels dreier verschiedener Nahttechniken (doppelte Kessler-Naht, doppelte Figure-of-eight-Naht, Running-interlocking-horizontal-Mattress-Naht) repariert. Danach erfolgte eine erneute Bestimmung der ED-Sehnenlänge in Zone IV. Die zuvor bestimmte Kraft, notwendig für eine volle Beugung und Streckung der Finger, wurde abwechselnd appliziert. Nach 20 Applikationen wurde untersucht, ob es zu einer Diastase der genähten Sehnen kam. Insgesamt wurden 200 Fingerbeugungen und -streckungen unter Verwendung der vorbestimmten Kraft durchgeführt und danach der Abstand zwischen den Sehnenstümpfen gemessen, wobei ein Spalt von 2 mm als Versagen der Naht gewertet wurde. Zeigte sich keine Nahtinsuffizient, erfolgten weitere 50 Bewegungszyklen unter Applikation der doppelten Kraft.

Ergebnisse Unabhängig von der angewandten Nahttechnik kam es bei allen ED-Sehnen durch die Naht zu einer signifikanten Verkürzung ihrer Länge in Zone IV. Eine signifikante Spaltbildung oder gar ein Versagen der Sehnennähte wurde nicht beobachtet.

Schlussfolgerung Alle 3 verwendeten Sehnennähte eignen sich für eine früh-aktive Nachbehandlung von Strecksehnendurchtrennungen in Zone IV. Entsprechend können Handchirurgen jene wählen, mit denen sie die meiste Erfahrung haben.



Publication History

Received: 11 November 2020

Accepted: 25 July 2021

Article published online:
28 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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