Prep and drape the patient in the standard sterile fashion
3
Administer the local anesthesia
4
Make an incision to expose the area of injury
5
Perform a thorough debridement of the wound
6
Identify the damaged flexor tendon
7
Approval: Surgeon for using a specific technique
8
Perform the repair considering the chosen technique
9
Use magnification to ensure accurate suture placement
10
Secure the ends of the repair with appropriate knots
11
Test the repair by flexing and extending the finger
12
Suture the surgical wound
13
Apply a sterile dressing and a protective splint
14
Provide postoperative instructions to the patient
15
Arrange for a follow-up after a week to check healing progress
16
Approval: Physician for initiating early rehabilitation
17
Plan and begin the rehabilitation if approval has been granted
18
Monitor patient recovery and evaluate the hand function
19
Schedule further follow-up visits as required
Ensure patient consent for the procedure
Before proceeding with the flexor tendon repair technique, ensure that the patient has given their informed consent. Explain the procedure, risks, and expected outcomes in a clear and understandable manner. Answer any questions they may have to alleviate any concerns or doubts.
Prep and drape the patient in the standard sterile fashion
Prepare the patient for the procedure by prepping and draping them in a standard sterile fashion. This is crucial to maintain a sterile environment and reduce the risk of infection. Ensure that all necessary instruments and materials are readily available.
1
Clean the surgical site
2
Apply sterile drapes
3
Place sterilized instruments nearby
4
Arrange sterile gauze and sutures
Administer the local anesthesia
Before initiating the flexor tendon repair technique, administer local anesthesia to the patient to ensure their comfort throughout the procedure. Take into consideration any allergies or medical conditions that may affect the choice of anesthesia.
1
Lidocaine
2
Bupivacaine
3
Mepivacaine
4
Procaine
5
Prilocaine
Make an incision to expose the area of injury
Make a carefully planned incision to expose the area of the flexor tendon injury. This step is essential for gaining access to the damaged tendon and allows for proper visualization during the repair process. Keep in mind the desired length and location of the incision for optimal access.
Perform a thorough debridement of the wound
Thoroughly debride the wound to remove any dead or contaminated tissue, foreign bodies, or debris. This step helps to create a clean environment for the repair and promotes proper healing. Be cautious not to damage healthy tissue during the debridement process.
1
Remove necrotic tissue
2
Clean wound with sterile saline
3
Remove foreign objects
4
Irrigate with antiseptic solution
Identify the damaged flexor tendon
Carefully identify the damaged flexor tendon to ensure accurate repair. Visualize the tendon and assess the extent of the injury. Take note of any accompanying injuries or conditions that may affect the repair technique or subsequent outcomes.
1
Flexor Digitorum Profundus (FDP)
2
Flexor Digitorum Superficialis (FDS)
3
Flexor Pollicis Longus (FPL)
4
Flexor Carpi Radialis (FCR)
5
Flexor Carpi Ulnaris (FCU)
Approval: Surgeon for using a specific technique
Perform the repair considering the chosen technique
Perform the flexor tendon repair using the chosen technique based on the specific injury and tendon involved. Utilize appropriate surgical instruments, sutures, and techniques to achieve a secure and stable repair. Take into account the type and location of the injury for optimal results.
1
Core suture technique
2
Modified Kessler technique
3
Locking loop technique
4
Four-strand technique
5
Silicone rod interposition
Use magnification to ensure accurate suture placement
To ensure precise and accurate suture placement during the repair, utilize magnification tools such as loupes or microscopes. This enhances visibility and allows for meticulous suturing, reducing the likelihood of complications or suture failure.
1
Loupes
2
Operating microscope
3
Headlamp with magnification
Secure the ends of the repair with appropriate knots
Secure the ends of the repaired tendon with appropriate knots to ensure stability and prevent suture loosening or breakage. Select the appropriate knot technique based on the chosen repair method. Ensure that the knots are tight, yet not overly constrictive to avoid compromising blood supply.
1
Square knot
2
Surgeon's knot
3
Modified Smack knot
4
Strickland knot
5
Mason-Allen knot
Test the repair by flexing and extending the finger
After completing the flexor tendon repair, manually flex and extend the patient's finger to assess the functionality and strength of the repair. Observe for any limitations, weakness, or abnormal movements. This step helps to confirm the successful restoration of finger movement and function.
1
Full range of motion
2
Limited flexion
3
Limited extension
4
Pain on movement
5
Abnormal finger position
Suture the surgical wound
Suture the surgical wound using an appropriate technique to achieve wound closure and facilitate proper healing. Select the type of suture material based on the location, tension, and expected healing timeframe. Pay close attention to wound approximation and alignment for optimal cosmesis.
Apply a sterile dressing and a protective splint
Apply a sterile dressing over the sutured wound to provide protection and promote a clean healing environment. Additionally, apply a protective splint to immobilize the repaired finger and prevent tension or excessive movement during the initial healing phase.
1
Apply sterile gauze
2
Secure with adhesive tape
3
Immobilize finger with splint
4
Check for proper fit and comfort
Provide postoperative instructions to the patient
Provide the patient with comprehensive postoperative instructions to ensure proper care and optimal healing. Include information on wound care, activity restrictions, pain management, and signs of potential complications. Offer the patient an opportunity to ask questions or seek clarification regarding the instructions.
Arrange for a follow-up after a week to check healing progress
Schedule a follow-up appointment with the patient after a week to assess the progress of healing and monitor the patient's recovery. This allows for the evaluation of the surgical site, removal of sutures if necessary, and adjustments to the treatment plan based on the individual's healing response.
Approval: Physician for initiating early rehabilitation
Will be submitted for approval:
Arrange for a follow-up after a week to check healing progress
Will be submitted
Plan and begin the rehabilitation if approval has been granted
If the patient's condition and healing progress permit, develop and initiate an appropriate rehabilitation plan. Collaborate with the rehabilitation team to establish a customized program that focuses on finger range of motion, strengthening, and functional activities. Ensure patient compliance and follow-up as necessary.
Monitor patient recovery and evaluate the hand function
Regularly monitor the patient's recovery progress and evaluate the functionality of the repaired hand. Assess finger range of motion, strength, grip strength, and sensation. Document any changes, improvements, or limitations observed during the recovery process for further treatment planning or adjustments.
Schedule further follow-up visits as required
Based on the patient's progress and individual needs, schedule further follow-up visits to monitor their ongoing recovery. This helps ensure that any delayed complications or concerns are addressed promptly, and the patient's hand function and overall outcome are optimized.
