<< Back to the abstract archive
Pulley Release and Reconstruction with Acellular Dermal Matrix after Zone 2 Flexor Tendon Injury
Marco Swanson MD, David E. Kurlander MD, Leigh-Anne Tu MD, Anand R. Kumar MD, Tobias C. Long MD, Kyle D. Lineberry MD, Joseph S. Khouri MD
Case Western / University Hospitals
2020-02-14
Presenter: Marco Swanson
Affidavit:
All work on this project represents the original work of the resident.
Director Name: Edward Davidson MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
PURPOSE:
We describe a novel technique and report our experience repairing zone 2 flexor tendon injuries with pulley release and reconstruction using ADM.
METHODS:
All patients who underwent zone 2 flexor tendon repair with pulley release and ADM reconstruction were retrospectively reviewed. Outcomes included age, follow-up, bow-stringing and stiffness, among others. Our technique involves wide awake surgery with local anesthesia and no tourniquet, when feasible. The entire pulley overlying the tendon injury is released by longitudinal midline incision. FDP and FDS are both repaired. The patient then actively ranges the finger and additional pulley release is performed as necessary. Pulley reconstruction is then performed with custom-cut ADM and secured to the pulley remnants. The finger is again actively ranged to confirm gliding under the ADM. Post-operative early active motion therapy follows.
RESULTS:
12 patients were identified over an 18-month period. Six patients were excluded due to follow-up less than 2 months. Six patients with 10 fingers treated remained for inclusion. Mean age was 39 years and mean follow-up 3 months. No patients demonstrated evidence of bow-stringing at last follow-up. Minimal or no stiffness was observed in 60% of patients, including one patient who was not compliant with therapy. Significant stiffness was observed in 40% of fingers, all in non-compliant patients.
CONCLUSION:
Successful management of zone 2 flexor tendon injuries can be accomplished with pulley release and reconstruction using ADM, without concern for bowstringing. Therapy compliance remains important to minimize stiffness.
