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Partial Laceration of Flexor Tendons


- Discussion:
    - w/ partial flexor tendon laceration which is proximal to A1 pulley:
          - enlarge the laceration if necessary;
          - if tendon is beveled, resect beveled edged
          - partially severed tendon should not be repaired if at least 30-40% of the tendon remains intact;
    - if level of paritial flexor tendon laceration is within digital sheath:
          - attempt to observe tendons as pt fully flexes & extends finger;
    - in the report by Al-Qattan MM, et al, the authors evaluated the role of conservative treatment in partial
          flexor tendon injuries;
          - over a 5-year-period 15 patients with zone II partial flexor tendon lacerations that were larger than half the width of the tendon were treated conservatively without tendon suturing;
          - surgical exploration was done with a digital block and the flexor tendons were observed as the patient fully extended and flexed the finger;
          - if present, the cause of triggering was determined and eliminated by trimming any beveled tendon edge, resection of the involved pulleys, and repair of the flexor sheath;
          - early protected mobilization was started the first day after injury using a dorsal splint.
          - at 4 weeks after injury the splint was removed and exercises against resistance were started.
          - ref: Conservative management of zone II partial flexor tendon lacerations greater than half the width of the tendon 

- Complications of Partial Rupture:
      - external or internal triggering of finger & entrapment;
             - if triggering persists, the sheath is opened, the tendon is repaired, & sheath is closed;
     - potential complication of internal triggering is prevented by repair of sheath & early motion or repair of tendon & resection of the C-1 pulley;
     - external triggering is prevented by early motion and partial resection of the A1 pulley;
     - entrapment is prevented by resection of the beveled edge of the tendon and repair of the sheath;
     - when A2 or A4 tendons are injured, consider repair over a silicone elastomer rod and subsequently removing rod & inserting a flexor tendon graft;
     - loss of A2 or A4 pulley results in bow string of flexor tendon across PIP & permanent flexion contracture of joint, which is extremely difficult to correct

Clinical Treatment of Partial Tendon Lacerations without Suturing and with Early Motion.

Effects of tenorraphy on the gliding function and tensile properties of partially lacerated canine digital flexor tendons.

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