Tendon Stuff Flashcards
(50 cards)
4 stages of tendon healing
Stage 1: The severed ends being joined by a fibroblastic splint. At the end of this stage the repair site is its weakest state consisting of serous material and granulation tissue
Stage II: Shows an increase in paratenon vascularity and collagen proliferation. Immobilization is necessary.
Stage 3: Collagen fibers begin to form longitudinally and give the tendon a moderate degree of strength. At this time controlled passive motion is beneficial to decrease the formation of fibrous adhesions.
Stage 4: Exhibits fiber alignment which imparts increased strength to the tendon. At this point active mobilization can be initiated.
***Each stage takes approximately 1 week
How do tendon lengthenings affect muscle strength?
Tendon lengthenings will often result in a loss of muscle strength roughly equal to one grade of manual examination once healed
Suture selections for tendons (5)
Surgilon
Stainless steel
Silk
Tevdek/Ticron
Vicryl Dexon
Surgilon in tendon procedures
This non-absorbable noninflammatory suture allows for increased strength during the end of stage one when the tendon is at its weakeset
Stainless steel in tendon procedures
excellent to anchor tendon to bone and then removed when healing occurs. It is the strongest and least reactive, and bet in contaminated wounds
Silk in tendon procedures
Was used for years but has been replaced with less reactive nonabsorbable and absorbables
Tevdek/Ticron
nonabsorbable braided polyester that retain greater ability to resist gap producing forces at 3 weeks than either nylon or polypropylene
Vicryl/Dexon
Absorbable polygalactic acid and polyglycolic acid usually provide strength long enough for repair
Methods of tendon to tendon suture techniques (8)
Bunnell end-to-end
Double right angle
Lateral trap
Chicago
Robertson
Interlace
Herringbone
Bunnell pull-out suture
Bunnell end-to end
excellent technique but can cause tissue restriction
Double right angle
good for quick repair of small tendons
Lateral trap
firmly grips the outside of the tendon without constriction the microcirulation in the center.
Central mattress suture acts as a temporary anchor
Chicago
a simple x-stitch described by Mason and Allen
Robertson
an excellent method of anastamosing tendons of unequal diameter
Interlace
another method for attaching smaller to larger tendons as in tendon grafting
Bunnell pull-out suture
A pull out stitch is a non-absorbable suture that anchors a deep stitch to the outside of the skin so it can be removed once healing is complete. Anchored to the outside with a button
Methods for securing tendon to bone: methods (6)
Trephine plug
Three hole suture
Buttress and button anchor
Tunnell with sling
Crew and washer
STATAC Device
Trephine plug
Using a Michele vertebral trephine a hole is drilled into the bone with the tendon pressed inside and the resultant plug is later tapped into place securing the tendon
Three hole suture
Anchoring the transposed tendon with a double armed suture and placing it in a drill hole.
The sutures are then tied into 2 adjacent small drill holes
Buttress and button anchor
for tenodesis using a nonabsorbable suture that is removed once the healing is complete
Tunnel with sling
Can only be used with a tendon with sufficient length. Made via a tunnel in a bone with the tendon passed through and sutured on itself.
Used with a Jones suspension of the EHL
Screw and washer
Useful where there is little soft tissue for the transferred tendon can be sutured
STATAC device
Titanium implant that is drilled into the bone with non-absorbable sutured attached that can be threaded to Keith needles and sewn through a tendon
Objectives of tendon transfer (6)
- to improve motor function where weakness and imbalance exist and thereby prevent contractures and further deformity
- to eliminate deforming forces
- To provide active motor power
- to provide better stability
- to eliminate the need for bracing
- to improve cosmesis
