title: Avoiding flexor tendon repair rupture with intraoperative total active movement examination.
abstract: BACKGROUND
  Wide-awake flexor tendon repair in tourniquet-free unsedated patients permits intraoperative Total Active Movement examination (iTAMe) of the freshly repaired flexor tendon. This technique has permitted the intraoperative observation of tendon repair gapping induced by active movement when the core suture is tied too loosely. The gap can be repaired intraoperatively to decrease postoperative tendon repair rupture rates. The authors record their rupture rate in the first 15 years of experience with iTAMe.
  
  
  METHODS
  This was a retrospective chart review of 102 consecutive patients with wide-awake flexor tendon repair (no tourniquet, no sedation, and pure locally injected lidocaine with epinephrine anesthesia) in which iTAMe was performed by two hand surgeons in two Canadian cities between 1998 and 2008. Intraoperative gapping and postoperative rupture were analyzed.
  
  
  RESULTS
  The authors observed intraoperative bunching and gap formation with active movement in flexor tendon repair testing (iTAMe) in seven patients. In all seven cases, they redid the repair and repeated iTAMe to confirm gapping was eliminated before closing the skin, and those seven patients did not rupture postoperatively. In 68 patients with known outcomes, four of 122 tendons ruptured (tendon rupture rate, 3.3 percent) in three of 68 patients (patient rupture rate, 4.4 percent). All three patients who ruptured had accidental jerk forced rupture. All those patients who did what we asked them did not rupture.
  
  
  CONCLUSIONS
  Tendons can gap with active movement if the core suture is tied too loosely. Gapping can be recognized intraoperatively with iTAMe and repaired to decrease postoperative rupture.
authors.affiliation: Saint John, New Brunswick, and Ottawa, Ontario, Canada From Saint John Regional Hospital, Dalhousie University, and Ottawa University.
authors.forename: Amanda
authors.initials: A
authors.lastname: Higgins
authors.forename: Donald H
authors.initials: DH
authors.lastname: Lalonde
authors.forename: Michael
authors.initials: M
authors.lastname: Bell
authors.forename: Daniel
authors.initials: D
authors.lastname: McKee
authors.forename: Jan F
authors.initials: JF
authors.lastname: Lalonde
mesh_terms: D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000517:prevention & control; D013710:Tendons / Q000601:surgery*
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