Clinical experience of using loop threads for tendon suturing of injured tendons of finger flexors in children's hands

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Abstract

BACKGROUND: Despite a significant progress in hand surgery, to date, the number of unsatisfactory functional outcomes in patients with injured flexor tendons of fingers still remains high, which underlines the importance and significance of the problem of flexor tendon repair in children.

CLINICAL CASE DESCRIPTION: The authors present a series of clinical cases with the application of loop threads for suturing tendons in children with tendon injuries in deep finger flexors at different anatomical sites. They share their experience in using loop threads for tendon suturing in zones II, III, IV, V including tendon end reinsertion in zone I again with a loop thread. The primary task of surgical treatment of children with injured tendons of finger flexors is their restoration. In order to prevent secondary tendon ruptures, finger contractures, infectious complications and scarring of the tendon with surrounding tissues, it is recommended to use optimal suture material and surgical sutures that meets the basic requirements for tendon suturing . Specific pediatric anatomy must be taken into consideration as well. As the authors' clinical experience shows, a new approach to the restoration of injured finger flexor tendons with loop threads allows to avoid complications in 98% of cases.

CONCLUSION: The implementation of loop tendon suturing into pediatric practice in combination with appropriate rehabilitation and motivation for the rehabilitation of a child and his/her parents opens up new prospects for the successful treatment of children with injured tendons of deep flexors of hand fingers.

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About the authors

Lamiya Ya. Idris

The Russian National Research Medical University named after N.I. Pirogov; Filatov N.F. Children's City Hospital

Author for correspondence.
Email: idrislamiya@mail.ru
ORCID iD: 0000-0002-4902-7939
SPIN-code: 1193-7787

MD

Россия, Moscow; Moscow

Alexander V. Alexandrov

The Russian National Research Medical University named after N.I. Pirogov

Email: alexmicrosurg@mail.ru
ORCID iD: 0000-0002-6110-2380
SPIN-code: 5229-0038

MD

Россия, Moscow

Dmitry Yu. Vybornov

The Russian National Research Medical University named after N.I. Pirogov; Filatov N.F. Children's City Hospital

Email: dgkb13@gmail.com
ORCID iD: 0000-0001-8785-7725
SPIN-code: 2660-5048

MD, Dr. Sci. (Medicine), Professor

Россия, Moscow; Moscow

Pavel V. Goncharuk

The Russian National Research Medical University named after N.I. Pirogov

Email: goncharukpavel@yandex.ru
ORCID iD: 0000-0002-9560-037X
SPIN-code: 6801-9875

MD

Россия, Moscow

Alexander N. Evdokimov

The Russian National Research Medical University named after N.I. Pirogov

Email: pediatrix@yandex.ru
ORCID iD: 0000-0002-9113-3612

MD

Россия, Moscow

Nikolay V. Lvov

The Russian National Research Medical University named after N.I. Pirogov

Email: dr.stillpoint@gmail.com
ORCID iD: 0000-0001-5169-8312

MD

Россия, Moscow

Alexander A. Smirnov

The Russian National Research Medical University named after N.I. Pirogov; Filatov N.F. Children's City Hospital

Email: smirnovaan@bk.ru
ORCID iD: 0000-0002-7274-8291

MD

Россия, Moscow; Moscow

Ruslan A. Khagurov

The Russian National Research Medical University named after N.I. Pirogov; Filatov N.F. Children's City Hospital

Email: dr.khagurov@gmail.com
ORCID iD: 0000-0001-7944-8438
SPIN-code: 2428-5302

MD

Россия, Moscow; Moscow

References

  1. Huynh MN, Ghumman A, Agarwal A, Malic C. Outcomes after flexor tendon injuries in the pediatric population: A 10-year retrospective review. Hand (NY). 2022;17(2):278-284. doi: 10.1177/1558944720926651
  2. Moeller R, Mentzel M, Vergote D, et al. [Treatment of flexor tendon injuries in children. (In German)]. Unfallchirurg. 2020;123(2):97-103. doi: 10.1007/s00113-019-00757-7
  3. Kato H, Minami A, Suenaga N, et al. Long-term results after primary repairs of zone 2 flexor tendon lacerations in children younger than age 6 years. J Pediatr Orthop. 2002;22(6):732-735.
  4. Nietosvaara Y, Lindfors NC, Palmu S, et al. Flexor tendon injuries in pediatric patients. J Hand Surg Am. 2007;32(10):1549-1557. doi: 10.1016/j.jhsa.2007.08.006
  5. Al-Qattan MM. Zone I flexor profundus tendon repair in children 5-10 years of age using 3 "figure of eight" sutures followed by immediate active mobilization. Ann Plast Surg. 2012;68(1):29-32. doi: 10.1097/SAP.0b013e31820e0e19
  6. Sikora S, Lai M, Arneja JS. Pediatric flexor tendon injuries: A 10-year outcome analysis. Can J Plast Surg. 2013;21(3):181-185. doi: 10.1177/229255031302100304
  7. Lee SK, Schreiber JJ. Flexor tendon injuries. The Pediatric Upper Extremity. 2014;1-23.
  8. Pan ZJ, Pan L, Xu YF, et al. Outcomes of 200 digital flexor tendon repairs using updated protocols and 30 repairs using an old protocol: experience over 7 years. J Hand Surg Eur. 2020;45(1):56-63. doi: 10.1177/1753193419883579
  9. Dawood AA. Repair of flexor tendon injuries by four strands cruciate technique versus two strands kessler technique. J Clin Orthop Trauma. 2020;11(4):646-649. doi: 10.1016/j.jcot.2020.05.038
  10. Chang MK, Wong YR, Tay SC. Biomechanical comparison of modified Lim/Tsai tendon repairs with intra- and extra-tendinous knots. J Hand Surg Eur. 2018;43(9):919-924. doi: 10.1177/1753193418769804
  11. Chen J, Wu YF, Xing SG, Pan ZJ. Suture knots between tendon stumps may not benefit tendon repairs. J Hand Surg Eur. 2018;43(9):1005-1006. doi: 10.1177/1753193418788939

Supplementary files

Supplementary Files
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2. Fig. 1. Distribution of patients with deep finger flexor tendon injuries in the zone of fibrous synovial canals by gender and age depending of the type of traumatic object in the period from 2017 to 2021 (n=112).

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3. Fig. 2. Clinical case №1: a — wound view at the moment of admission; b — tendon end exposed in the wound; c — tendon preparation for reinsertion; d — view after reinsertion.

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4. Fig. 3. Clinical case №2: a — view of the wound at the moment of admission; b — the end of the tendon exposed in the wound; c — view after loop suture of the flexor tendon; d — repaired finger cascade.

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5. Fig. 4. Clinical case № 3: a — loop suture of the flexor tendon in zone III; b — repaired finger cascade.

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6. Fig. 5. Clinical case № 4: a — intraoperative view of the wound (damaged structures are visible — ulnar and median nerves, superficial branch of ulnar artery, tendons of flexors of the 2nd and 5th fingers); b — view of the repaired median nerve; c — result after 12 months of treatment.

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7. Fig. 6. Clinical case № 5: a — the ends of the damaged superficial flexors of the 2nd, 3rd and 4th fingers, deep flexors of the 3rd and 4th fingers are brought into the wound; b — a view of the flexor tendon of the 3rd finger restored by loop sutures.

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8. Fig. 7. Ellen 4/0 loop thread.

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