- See:
Nerve Repair
- Discussion: Zone IV:
- extends from distal end of
transverse retinacular ligament to proximal margin;
- combined nerve - tendon procedure may be delayed for 21 days if wound is
contaminated, if crushing trauma has occurred;
-
median nerve management:
- lacerations of flexor tendons within the carpal canal are typically assoc w/ partial or complete laceration of
median nerve;
- nerves should be repaired first and the tendons last;
- median nerve may be repaired primarily in a clean wound;
-
median nerve is aligned by noting the proximal and distal central arteries, and by
proximal and distal electric stimulation (< 48 hrs);
- delayed electrical stimulation is possible with the patient awake;
- distal nerve, however, may not show motor & sensory fibers stimulation;
- tension is removed from nerve suture line by flexing wrist 30 deg and MP joints 60 deg;
- post op:
- digit can be manipulated toward extension, provided wrist in maintained in 30 deg of flexion;
- main complication formation of adhesions between the flexor tendons and the carpal walls;
- Discussion: Zone V:
- extends from the proximal
transverse carpal ligament at the wrist to musculocotinous junction of flexor tendons in forearm;
- in this area there may be concomitant
ulnar nerve &
artery damage as well as
radial artery &
median nerve damage;
- primary repair of the arteries is usually indicated;
- if wound is contaminated, arteries are repaired and delayed repair of tendons and nerves is planned;
-
post op:
- wrist is maintained in volar flexion for 21 days and gradually brought into dorsiflexion during the subsequent 6 weeks;
- references:
- ref:
Optimizing independent finger flexion with zone V flexor repairs using the Massachusetts General Hospital flexor tenorrhaphy and early protected active motion.
