Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Palo Alto, CA 94304, USA.
Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Palo Alto, CA 94304, USA.
Hand Clin. 2023 May;39(2):203-214. doi: 10.1016/j.hcl.2022.08.021. Epub 2023 Feb 14.
Complications in flexor tendon repair are common and include tendon rupture, adhesion formation, and joint contracture. Risk factors include preexisting conditions, gross contamination, concurrent fracture, early unplanned loading of the repaired tendon, premature cessation of splinting, and aggressive early active range of motion protocols with insufficient repair strength. Rupture of a repaired tendon should be followed by early operative exploration, debridement, and revision with a four-core strand suture and nonbraided epitendinous suture. Wide-awake flexor tenolysis should be considered when adhesion formation results in the plateaued range of motion, and passive motion exceeds active motion. Two-staged reconstruction is recommended when injury results in excessive scaring, joint contracture, or an incompetent pulley apparatus.
屈肌腱修复术后常见并发症包括肌腱断裂、粘连形成和关节挛缩。危险因素包括原有疾病、严重污染、并发骨折、修复后的肌腱过早计划性负重、夹板过早去除以及早期主动活动范围协议过于激进，修复强度不足。修复后的肌腱断裂应行早期手术探查、清创，并采用 4 股线缝合和非编织腱膜缝合进行修复。如果粘连导致运动范围平台化，且被动活动超过主动活动，则应考虑清醒状态下的屈肌腱松解术。当损伤导致过度瘢痕形成、关节挛缩或滑车装置功能不全时，建议进行两阶段重建。
