Key notes on plastic surgery/Adrian M. Richards

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38 GENERAL PRINCIPLES
• Tendon weaves are more secure than end-to-end repairs.
• The technique most commonly used was described by Pulvertaft and is known
as the Pulvertaft weave.
• In this technique the tendons are woven together by passing their ends through
three or four longitudinal slits in the body of the other tendon.
Rehabilitation following repair of flexor tendons
• Until relatively recently, tendons were immobilized post-operatively.
• There is now a trend towards earlier mobilization.
The post-operative rehabilitation regimens may consist of the following.
Immobilization
Immobilization is used mainly in children and adults considered unsuitable for
early mobilization.
Early passive mobilization
• This involves regular passive motion of the joints.
• No active movement is permitted.
Early active extension with passive flexion
• This regimen was advocated by Kleinert et al.
• A dorsal splint protects against hyperextension.
• Finger flexion is maintained by rubber-band traction.
• The rubber bands are attached to the fingernail and the volar aspect of the splint.
• Active extension can occur against the elastic recoil of the bands.
• Passive flexion occurs by the elastic recoil of the bands.
Early active mobilization
• The ‘Belfast’ regimen is widely used.
• This involves the fitting of a dorsal splint which leaves the fingers free to flex.
• The splint should hold the wrist between neutral and 30° of flexion.
• It should limit MCP extension to 70° of flexion.
• It should limit hyperextension of the interphalangeal joints (IPJs) beyond the
neutral position.
• The fingers are left free on their volar surfaces.
• Active mobilization is started in the early post-operative period. This consists of
the following three elements.
Passive flexion
This mobilizes the joints and prevents their contraction.
Passive flexion and hold
• This produces an isometric force on the proximal muscle bellies.
• This helps to maintain their function.