| Title |
Lenkiamųjų sausgyslių pažeidimų gydymas rankoje, sausgyslės siuvimo metodai, siūlės tipai, modifikacijos, skirtingų siūlių pritaikymas praktikoje. Siuvimo medžiagos pasirinkimas ( monofilamentas, pintas siūlas, tirpstantis siūlas). Pooperacinė priežiūra, reabilitacija / |
| Translation of Title |
Teatment of flexor tendon lesions in the hand, tendon suture methods, suture types, modifications, application of different suture techniques in practise. choice of sewing material (monofilament, braided thread, absorbable thread). postoperative care, rehabilitation. |
| Abstract [eng] |
Injuries to the flexor tendons of the hand remain a major burden on the health system not only in the third world countries, where patients are more likely to suffer from poor working and living conditions, but also in developed countries. Methods for the treatment of these lesions differ in different clinics, therefore, the aim of this study was to review the latest literature and compare different flexor tendon suture techniques, suture material used, postoperative care, and rehabilitation. The literature was searched using PubMed, Google Scholar, Web of Science, Science Direct and Clinical Key research databases, from which 79 publications were selected and reviewed. The scientific literature indicates that accurate restoration of the anatomy of the deep and superficial digital flexor tendons during surgical treatment is necessary. In the case of complicated lesions in the flexor zone II, one of the two branched parts of the superficial flexor tendon can be resected. It is recommended to repair flexor tendons with either one of the double Kessler, double Tsuge and six-stranded M-Tang core sutures and with an epitendinous suture, which should be done in deep stitches and dense loops. Of the most commonly used suture material, braided polyester has the highest tensile-strength and is the most resistant to the untying of knots. Recently developed monofilament polyfluoroethylene has even higher tensile strength, is more convenient for adaptation of the cut ends of the tendon, induces lower inflammatory reaction and is associated with lower risk of infection. Surgeons should prioritize multi-strand core suture repair over an increase in suture caliber. After surgery, the hand is immobilized with a splint that holds the wrist, metacarpophalangeal, and interphalangeal joints in flexion at 30 °, 40 °, and 30 ° respectively. During the period from the 3rd to the 45th postoperative day, in case of intact or restored superficial digital flexor tendon, it is recommended to use the Elliot protocol of early active rehabilitation. Beyond 45 days after surgery, individualized exercises are recommended, selected based on the patient's complaints and clinical examination. |
