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Wound Complications Following Simultaneous Extensor and Flexor Tenolysis of the Digits
Robert Strazar, MD; Avinash Islur, MD, FRCSC
University of Manitoba, Winnipeg, MB, Canada
Purpose of Study: Most hand literature suggests that digital extensor and flexor tenolysis be performed in a staged fashion rather that at the same operation. Complications of such a simultaneous procedure is thought to be related to a compromise in digital blood supply resulting in delayed wound healing, partial skin flap necrosis, or digital ischemia. The purpose of this study was to retrospectively review all wound healing complications in cases performed by a single surgeon in which simultaneous digital extensor and flexor tenolysis was performed and the approach utilized.
Methods: A retrospective chart review of all patients undergoing simultaneous flexor and extensor tenolysis between 2008-2016 in a single surgeons practice was performed.
Surgical approach was performed in the following order: 1) extensor tenolysis via a dorsal lazy-S incision or a dorsal straight-line longitudinal incision, 2) Open PIP arthrolysis through a partial collateral ligament release, 3) Flexor tenolysis via a modified Brunner. Patients underwent a release of the A1 pulley and exploration of the flexor tendons. If proximal FDS/FDP tendon pull did not result in PIP/DIP range of motion (ROM) a formal flexor tenolysis was performed throughout zones 1/2/3. Patients undergoing only an exploration of the flexor tendons at the A1 pulley were excluded from the study. Physiotherapy/Occupational Therapy and the surgeons’ notes were reviewed for findings of wound healing complications including but not limited to swelling, hematoma, wound dehiscence, partial or complete skin flap necrosis.
Results: Thirty-two patients underwent simultaneous digital extensor and flexor tenolysis between 2008-2016. All patients had previously suffered closed or open phalangeal fractures treated conservatively with closed reduction and splinting alone or closed/open reduction with Kirschner wire fixation. Twenty cases of digital swelling, 2 cases of partial wound dehiscence resulting in uneventful delayed wound healing, and 1 case of hematoma evacuated through the dorsal incision were reported. No cases of partial or complete skin flap necrosis occurred. There were no cases of digital ischemia or compromise.
Conclusion: Simultaneous digital extensor and flexor tenolysis can be safely performed and must be considered in patients with severe stiffness post phalangeal fracture. Due to almost universal swelling in these patients, initiation of formal ROM by physiotherapy may be delayed for 1 week post-operatively. When performed appropriately, there is little threat to the skin flaps or digital vascular supply.
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