A tendon laceration in the hand can be a very significant injury which impacts on patient’s ability to use a hand and participate in normal work activities.
Hand lacerations are best explored with tourniquet control under general anaesthetic. This allows complete inspection of all the tissues in the injury zone. Sometimes patients will only have sustained a partial laceration of the tendon which may not require formal repair. If more than 50% of the tendon has been cut or if the tendon has been completely divided, then a formal repair will be needed. In the case of flexor tendons, the cut ends can retract considerably. Sometimes the skin incision will have to be extended significantly to allow the tendon ends to be located and retrieved.
Strong core sutures are inserted into the tendon to hold ends together. A superficial stitch is then placed around the outer wall of the tendon to ensure that there is a smooth neat surface.
Once a tendon has been repaired, it must be protected for an extended period. This means wearing a splint full time for at least the first six weeks. After this, patients will usually start gradually weaning out of the splint. By eight weeks, patients are often able to remain out of the splint. Great care is still required up to the three-month stage following a tendon repair.
In the early stages of healing, the tendon becomes very soft. If patients remove the splint and stretch the tendon repair, it is likely that the repair will fail. It takes at least three months for the tendon to get back to good strength.
Because of the prolonged recovery period and rehabilitation, a tendon laceration can impact hugely on a patient’s day-to-day activities and their employment.
Injuries to the flexor tendons can present a major challenge regaining the range of movement of the digits. Whilst the tendon repair must be protected, some gentle early movement of the tendon often reduces the formation of adhesions around the tendon as it heals. Hand therapy is important in achieving a good outcome following flexor tendon repair.