Tendon Repair

A tendon attaches a muscle to a bone so that when the muscle contracts the tendon pulls on a bone which helps the joint bend. Without tendons, complicated and coordinated movements are impossible. There are extensor tendons which extend a joint and there are flexor tendons which flex a joint. Many other movements are possible, such as abduction (moving away from the midline), adduction (moving towards the midline), or rotation. These movements are all related to tendons and the muscles attached to the tendons. When a tendon is injured, movements relating to that tendon will be affected and repairing the tendon will help restore those movements.

Tendon injuries are usually associated with some sort of trauma. The trauma can be from a crush, a cut, an avulsion, a fracture or any number of injuries. Multiple tendon injuries are also possible depending upon the seriousness of the injury. Regardless of the number of tendons injured, understanding how tendons are repaired allows for the restoration of function.

After a tendon is repaired, tendon healing begins. There is usually limited movement or in some cases no movement of the tendon. The circumstances will determine if limited movement or no movement will be required. The operating surgeon will be making that decision.

However, if the tendon injuries are part of a larger and more traumatic event in which multiple injuries have occurred (e.g. a patient with head trauma with fractured long bones, a collapsed lung and cardiac contusion who is on a ventilator from a motor vehicle accident), then the tendon will heal but movement of the injured tendons may or may not occur. It will depend upon the circumstances.

Some of the less complicated tendon repairs are seen in the back of the hand (on the dorsal surface). It should be understood that all tendon repairs are complicated and deserve special attention to optimize healing. An isolated single tendon laceration can usually be repaired in the office under most conditions (e.g. not associated with any other trauma in a healthy patient.) This is due primarily to the tendons being located superficially. However, a lacerated flexor tendon located in the palm of the hand is not usually repaired in the office. This is because so many important structures are located in the palm of the hand (e.g. nerves and blood vessels which need to be clearly visualized to avoid injury.) These are some reasons flexor tendon injuries are taken to the operating room for repair.

There are many ways to repair a tendon but it usually is related to the size of the tendon. Some tendons are large enough to be able to place a core suture within the center of the tendon and some smaller sutures around the periphery. Other tendons are very small and cannot hold a core suture. The location of the tendon injury is also an important factor that determines how a tendon is repaired. A tendon that is pulled off of its insertion into the bone is treated differently than a tendon that is lacerated where the muscle is attached to the tendon or where the tendon is no longer attached to the muscle at all.

Surgeons train for years in residency training programs to learn about tendon repairs, and a surgeon who is board certified by any specialty who treats tendon injuries is qualified to perform a repair tendon.

At Reynolds Plastic Surgery, the tendons most often repaired are tendon in the hands which flex and extend the structures in the upper extremities.

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