What surgical procedure is used for tendon repair of the thumb?

Surgical Procedures for Thumb Tendon Repair

For thumb tendon repair, surgical techniques typically include excision of abnormal tendon tissue and performance of longitudinal tenotomies to release areas of scarring and fibrosis, with specific procedures varying based on the tendon involved and extent of injury. 1

Types of Surgical Procedures

• Open repair is a procedure using an extended incision for exposure, allowing visualization of the rupture and tendon to allow direct placement of sutures for the repair 1
• Limited open repair uses a small incision for exposure, allowing direct visualization of the ruptured tendon ends 1
• Percutaneous repair is performed without direct exposure of the tendon rupture site 1

Specific Tendon Repair Techniques

• The Pulvertaft weave technique is frequently used during tendon repairs and transfers, though it has some limitations 2
• Alternative techniques to the Pulvertaft weave include:
  • Side-to-side (STS) technique, which has been shown to have higher yield strength than the Pulvertaft technique 2
  • Step-cut (SC) technique, which demonstrates similar strength to the Pulvertaft technique 2
  • Wrap around (WA) technique, which has superior yield strength compared to the Pulvertaft technique 2
• The spiral linking technique, where one end of the tendon is spiraled around the other end, matches the strength of the Pulvertaft method while absorbing more energy before failure 3

Considerations for Specific Thumb Tendons

• For extensor tendon injuries (extensor pollicis longus, extensor pollicis brevis, and abductor pollicis longus):
  • Open injuries require tendon reconstruction by suture followed by immobilization 4
  • Different aftercare protocols are needed depending on the zone of injury - static splinting for distal injuries and dynamic treatment for proximal injuries 4
  • Closed chronic ruptures of the extensor pollicis longus tendon may require a tendon transfer or tendon autograft due to the resulting defect 4

Post-Surgical Management

• Early mobilization after robust tendon repairs is favored to avoid tethering of the long tendons of the thumb during the early post-operative period 5
• Maintenance of full and rapid movement of the interphalangeal joint is vital to the full function of the thumb and is more likely to be retained using early mobilization of tendon repairs 5
• Suture material selection is crucial - nonabsorbable, synthetic fibers that are relatively strong (such as Supramid or prolene) are most desirable 6

Important Considerations and Pitfalls

• Immediately after tendon repair, the tendon contributes nothing to the strength of repair - the suture itself and suture technique are the sole contributors to repair strength 6
• The simplest and least traumatic suture technique, though initially weakest, allows tendon healing to proceed more rapidly when protected from tension 6
• Between three and six weeks post-repair, the suture material and technique become secondary to tendon healing as the primary provider of tensile strength 6
• Less traumatic suture techniques facilitate closure of the tendon sheath, which acts as a mechanical barrier to adhesion formation and re-establishes the continuity of the synovial fluid system 6