Treatment of tendon injuries by suturing. Rehabilitation

Treatment of damaged tendons by suturing

A tendon is a bundle of connective tissue fibers that attaches to a muscle. The treatment of tendon injuries is quite difficult - in case of their complete or partial rupture, doctors have to apply stitches. If the technique of the procedure is violated, various complications may arise - for example, problems with blood supply to the tendons, the formation of knots on their surface.

Rules for suturing different types of tendons

Common recommendations that will help to apply a tendon suture correctly and without complications:

• any seam must be technically simple;
• in the process of joining the torn fibers, the blood supply should not be disturbed;
• during the manipulation of suturing, the fibers and tendons must be aligned as much as possible;
• the number of ligatures (stitching threads) used should be minimal;
• the seam should firmly connect the fragments of damaged fibers.

Types of tendon sutures

Classification of tendon seams:

1. By the time of application, sutures are primary (those that are applied within the first day after injury), secondary early (they are applied after 4-6 weeks after healing of soft tissue wounds), secondary late (applied after 6-8 weeks) . During this period of time, it may be necessary to treat inflammation of the tendons.
2. According to the method of application, the usual types of tendon sutures are distinguished (the sutures are on the surface of the tendon), intra-truncal, immersed between tendon fibers, and combined.
3. Two types of tendon sutures are distinguished by the place of application: located outside the synovial sheaths and inside them. In the first case, the damaged fragment of the tendon is first cut out and then sutured.

Peculiarities of tendon suturing operation

The choice of suturing method depends on the topographical and anatomical features of the tendons. For example, the suture of the extensor tendon is applied quite easily, the manipulation can be performed even in polyclinic conditions. This is due to the fact that the tendon is located superficially, does not have a synovial sheath, and its ends do not diverge after crossing.

And it is not easy to put a seam on the tendons of the flexors of the fingers, because they are located deep, have a synovial membrane, and when they break, their ends diverge far from each other.

The suturing procedure is carried out only in hospital conditions, for which experienced surgeons or traumatologists are involved. It is especially important to perform the "jewellery" manipulation in the case of applying a seam of the tendon of the flexors or extensors of the fingers. The functionality of the fingers depends on it.

Achilles tendon suture should be applied on the first day after the injury in order to preserve the function of the foot. Similar injuries occur in athletes, and for them complete recovery is important for professional activity.

The operation to apply a suture to the Achilles tendon is not always performed, often the problem of its damage is solved by applying a fixing bandage or plaster.

Recovery after injury

The rehabilitation process begins immediately after sutures are applied and lasts for several weeks (depending on whether a finger extensor tendon suture or other sutures were applied):

1. During the first 7 days, a "glue" is formed at the junction of the fibers - it cannot withstand even minimal tension.
2. In the second week, there is a powerful proliferation of connective tissue and vascularization of the seam.
3. During 15-21 days of the postoperative period (for example, when applying a seam of the Achilles tendon), the lumen between the already connected fibers of the tendon begins to be filled with connective tissue. It is during this period of rehabilitation that the patient can begin to activate.
4. On the fourth week, the tissue regeneration process ends and the tendon regains its former strength - the patient can actively load it.

If the rehabilitation period passes without complications, then a month after the operation the patient is allowed to start an active life. The process of complete recovery can last several weeks, and the acceleration of recovery is facilitated by physiotherapeutic procedures, massage and physical therapy.

More details about the cases in which sutures are placed on the tendons and what the complications of this manipulation can be can be found on the pages of our website dobrobut.com .