Kadar Assaf, Gur Shanny, Schermann Haggai, Iordache Sorin D
Hand Surgery Unit, Department of Orthopedics, Rabin Medical Center, Petah Tikva, Israel.
Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Plast Surg (Oakv). 2024 Feb;32(1):127-137. doi: 10.1177/22925503221088841. Epub 2022 Apr 5.
Flexor tendon laceration is often followed by retraction of the proximal stump. The goals of this review were to describe the myriad of proximal stump retrieval surgical techniques and where available to provide the clinical evidence associated with each. A Medline and Web of Science search was performed to identify any publication whose primary purpose was to describe a tendon retrieval technique. The techniques were assigned to 8 groups. Clinical outcomes, where reported, and advantages and disadvantages of the technique as reported by the authors of the articles were analyzed. Eight-hundred and forty-one publications complied with the search terms, and 33 articles were included in the current analysis. Only 2 of these articles were randomized controlled trials, and they were of low quality. There is no high-quality evidence to allow quantitative comparison of tendon retrieval techniques. An incremental approach can be recommended based on the qualitative review. After failed atraumatic attempts to retrieve the tendon by milking, retrieval should be done through proximal incision at the A1 pulley level, preferably without pulling the tendon out of the wound. When available, using an endoscope to retrieve the tendon appears to be a promising alternative.
屈指肌腱断裂后常伴有近端残端回缩。本综述的目的是描述多种近端残端找回手术技术，并在可行的情况下提供与每种技术相关的临床证据。通过检索医学文献数据库（Medline）和科学网（Web of Science），以识别任何主要目的是描述肌腱找回技术的出版物。这些技术被分为8组。对已报道的临床结果以及文章作者所报告的技术优缺点进行了分析。有841篇出版物符合检索词要求，本分析纳入了33篇文章。其中只有2篇文章是随机对照试验，且质量较低。没有高质量的证据可用于对肌腱找回技术进行定量比较。基于定性综述，可推荐一种渐进式方法。在通过挤奶法进行无创找回肌腱失败后，应在A1滑车水平通过近端切口进行找回，最好不要将肌腱拉出伤口。如有条件，使用内窥镜找回肌腱似乎是一种有前景的替代方法。
