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. 2024 Feb;32(1):127-137.
doi: 10.1177/22925503221088841. Epub 2022 Apr 5.

Techniques for Retrieval of Lacerated Flexor Tendons: A Scoping Review

Assaf Kadar  1 , Shanny Gur  1 , Haggai Schermann  2 , Sorin D Iordache  1
Affiliations

Techniques for Retrieval of Lacerated Flexor Tendons: A Scoping Review

Assaf Kadar et al. Plast Surg (Oakv). 2024 Feb.

Abstract
in English, French

Introduction: Flexor tendon laceration is often followed by retraction of the proximal stump. The goals of this review were to describe the myriad of proximal stump retrieval surgical techniques and where available to provide the clinical evidence associated with each. Methods: A Medline and Web of Science search was performed to identify any publication whose primary purpose was to describe a tendon retrieval technique. The techniques were assigned to 8 groups. Clinical outcomes, where reported, and advantages and disadvantages of the technique as reported by the authors of the articles were analyzed. Results: Eight-hundred and forty-one publications complied with the search terms, and 33 articles were included in the current analysis. Only 2 of these articles were randomized controlled trials, and they were of low quality. Conclusion: There is no high-quality evidence to allow quantitative comparison of tendon retrieval techniques. An incremental approach can be recommended based on the qualitative review. After failed atraumatic attempts to retrieve the tendon by milking, retrieval should be done through proximal incision at the A1 pulley level, preferably without pulling the tendon out of the wound. When available, using an endoscope to retrieve the tendon appears to be a promising alternative.

Introduction: Une lacération des tendons fléchisseurs est souvent suivie de la rétraction du moignon proximal. Les buts de cette revue étaient de décrire la myriade de techniques chirurgicales de récupération du moignon proximal et, quand cela était possible, de fournir les données probantes cliniques associées à chaque technique. Méthodes: Une recherche dans les bases de données Medline et Web of Science a été réalisée pour identifier toute publication dont l’objectif principal était de décrire une technique de récupération d’un tendon. Les techniques ont été réparties en huit groupes. Les résultats cliniques, quand ils étaient décrits, et les avantages et inconvénients de chaque technique tels que décrits par les auteurs des articles ont été analysés. Résultats: Huit cent quarante et une publications répondaient aux termes de la recherche et 33 articles ont été inclus dans la présente analyse. Seulement deux de ces articles étaient des essais contrôlés randomisés et ils étaient de mauvaise qualité. Conclusion: Il n’existe pas de données probantes de haute qualité qui permettent une comparaison quantitative entre les techniques de récupération des tendons. Une approche incrémentielle peut être recommandée en se basant sur la revue qualitative. Après des tentatives infructueuses de récupération du tendon par succion, la récupération devrait être faite par incision proximale au niveau de la poulie A1, de préférence sans tirer le tendon hors de la plaie. Quand cela est possible, l’utilisation d’un endoscope pour récupérer le tendon semble être une option prometteuse.

Keywords: endoscopy; flexor tendon; retraction; surgical technique; systematic review.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Study selection flowchart.
Figure 2.
Figure 2.
A suction tube is inserted to the tendon sheath; suction is activated and the tendon is pulled distally.
Figure 3.
Figure 3.
Reverse milking with an Esmarch as a method to apply pressure on the flexors tendons and “milk” the tendon out of its channel.
Figure 4.
Figure 4.
Pushing the tendon with hypodermic needles through the proximal incision. Panel: pulling the tendon distally with skin hooks.
Figure 5.
Figure 5.
Endoscope is inserted into the tendon sheath to visualize the retracted tendon. Panel: a grasper is used through the working channel to retrieve the tendon.
Figure 6.
Figure 6.
The shark nose technique to create a smooth interface between the end-to-end tendon-tube connection (right panel), pulling the tendon distally with a 2-incision technique (left panel).
Figure 7.
Figure 7.
Using steel wires for retrieval of the flexor tendon through a 2-incision technique. The wires are twisted to create a loop at the end through which the sutures are passed.
See this image and copyright information in PMC

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