Introduction
Traumatic injuries of the flexor tendons of the hand are very common and can leave serious consequences ranging from a simple reduction of force, until a major limitation of flexion, limiting the overall role of the hand.
In this article we will focus on the case of a patient who attended the Emergency Unit of the European Hospital Georges Pompidou (Paris). In this hospital there is a service that specializes in hand surgery, the rehabilitation is conducted according to specific protocols.
The patient of 44 years goes by a domestic accident (breakage of a plate). Presents a deep cut on the palm side of the Zone II of the left index finger. In his case presents no complete vascular injury but a common functional impotence of the Deep Flexor (FCP) and Common Flexor Surface (FCS) and a radial edge of the anesthesia of the finger.
Realizándosele surgery is a suture in the tendon, an anastomosis of the radial collateral artery and a suture of the radial collateral nerve.
The post is smooth and the patient started physical therapy the day after your operation.
Basic Concepts
Then, for a proper understanding, we proceed to explain some basic concepts
2.1) topographical areas
In 1961, the Truth and Michot propose a classification that includes seven anatomical areas to divide the hand. The International Federation of Hand Surgery amends in 1980. Currently comprises 5 zones and 3 fingers for the thumb.
In this case only develop different parts of the fingers except the thumb, as the case of our patient.
Zone 1: Insertion of the distal flexor surface and covers the insertion of the deep flexor of the base of the third phalanx.
Zone 2: Called “No Man’s Land”: It goes from the distal palmar crease to the middle of the second phalanx.
This area is interesting from the anatomical point of view because at this level the deep flexor appears “punch” to the superficial flexor.
Zone 3: Occupies since leaving the carpal tunnel until the digital channel. This area is conducive to good recovery.
Zone 4: Carpal Canal Zone. Corresponds to the carpal tunnel area covered by the annular ligament anterior carpal pulley makes avoiding the phenomenon of string arc during flexion of the wrist. The median nerve is the most vulnerable surface of the channel.
Zone 5: Since the union of the musculo-tendinous flexor to enter the carpal tunnel. In this area, the tendons are surrounded by a paratendón which allows movement of large amplitude. It is a very favorable area for recovery if there is a nerve-associated vascular injury. (more…)
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