Peradaban dibentuk oleh pikiran dan tangan-tangan yang terampil. Keterampilan tangan pada intinya merupakan kompleksitas dari gerakan fleksi pada tangan dan jari-jari. Perlukaan pada tendon flexor akan sangat mempengaruhi keterampilan seseorang dalam melakukan pekerjaannya. Dengan demikian, rekonstruksi yang optimal pada perlukaan tendon flexor tangan sangat diharapkan.

1. Pokok Bahasan
• Anatomi
• Diagnosis
• Terapi & pembedahan
• Komplikasi
1

2. Anatomi
2

3. 3 (Standring 2005)

4. 4
FDS
Vinculum
Longum
FDP
Vincula
Brevis
FIGURE 82.3. Flexor tendon sheath pulley system.
(Zidel 2007; Egeland et al 2012)
Procedure 7 | Acute Repair of Zone 1 Flexor Digitorum Profundus Av
FIGURE 7-4
Distal zone of
vascularization
Intermediate zone
of vascularization
Distal zone of
vascularization
Interphalangeal
trans. digital a.
Proximal trans.
digital a.
Distal trans.
digital a.
Branch to VLS
Proximal zone of
vascularization
FDS
FDP
VLS
VBS
VBP
VLP

5. 5
A5
A4
A3
A2
A1
C3
C2
C1
FDS FDP
2D
PA A1 A2 C1 C2 C3A3 A4 A
2C 2B 2A Su
FIGURE 8-7
FDS FDP
2D
PA A1 A2 C1 C2 C3A3 A4 A5 Pulleys
2C 2B 2A Sub-zones
(Egeland et al 2012)

6. Diagnosis
6

7. Pemeriksaan Fisik
• Kulit
• Muskuloskeletal
– Deformitas
– Nyeri pada fleksi / ekstensi
• Neurologis
– Diskriminasi dua titik statis
• Vaskuler
– CRT
– Allen test
(Seiler III 2017)
7
A
B

8. 8
curs, prompt repair is indicated.
Tendon ruptures may occur at the insertion on the bone or
musculotendinous junction, or occasionally at a diseased ten-
little more leeway in terms of tim
pliance obstacles. “Early second
tween 2 and 5 weeks. “Late seco
A-2 A-4
FIGUR
the ten
depend
The fing
the ten
DIP) an
tendon
fully ex
and ten
injury o
tendon
wound
Copyright © 2007 by Lippincott Williams & Wilkins, a Wolters Kluwer business.
Grabb and Smith's Plastic Surgery, Sixth Edition by Charles H. Thorne.(Zidel 2007)

9. Zone Tendon Fleksor
• Zone I: distal insersi FDS
• Zone II: puli A1 sd insersi FDS;
no man’s land
• Zone III: distal palmar crease
sd carpal tunnel
• Zone IV: carpal tunnel
• Zone V: distal antebrachii
• T I: distal sendi interphalang
• T II: phalang proximal
• T III: eminensia thenar
• T IV-V: sama dengan Zone IV-V
9
I
II
I
I
I
III
IIIII
I
IV IV
V
(Zidel 2007; Seiler III 2017)

10. Terapi & Pembedahan
10

11. Penyembuhan Tendon
• Kemampuan instrinsik, syarat: vaskularisasi & nutrisi
• Vaskularisasi: mesotenon à vincula
• Nutrisi: cairan sinovial
– Rekonstruksi tendon sheath
• Fase penyembuhan:
– Fase inflamasi: sd hari kelima
– Fase proliferasi / fibroplasia
– Fase remodelling: mulai minggu ke 3-6
• Mobilisasi aktif dini meningkatkan output
(Zidel 2007)
11

12. 12 (Kannus 2000)

13. Kekuatan maupun ukuran rekonstruksi dan vaskularisasi
tendon dapat meningkat dengan latihan dan gerakan,
sementara dihambat oleh imobilisasi.
Tendon yang diberikan regangan secara tepat akan
menyembuh lebih cepat, lebih kurang adhesinya, lebih
baik ekskursinya, meningkat kekuatannya lebih cepat
daripada tendon yang tidak diberikan regangan.
(Zidel 2007)
13

14. Prinsip
• Kuat: menghindari gap yang berpotensi
membentuk adhesi atau ruptur
• Smooth: fasilitasi gliding
• Disarankan 24-72 jam pertama
• Hindari manipulasi berlebihan
• Pegang pada core agar tidak merusak epitenon
• Teknik berbeda pada masing-masing zone
(Wilhelmi 2014)
14

15. Menjahit
Tendon (1)
15
(Zidel 2007)
A
B
C
D
Kessler
Bunnel
Kessler Modifikasi
Pulvertaft

16. Menjahit Tendon (2)
16
CHAPTER 6 Flexor Tendon Injury 193
Retracted
FIGURE 6.12 A to D, Four-strand modified Becker repair (see text). (Copyright Elizabeth Martin.)
A1
A
A1
B1
A
A B
C D
ing flexor tendon injuries. When the flexor tendon is tran·
sected, the finger will have impaired flexion. Pain may limit
the utility of this exercise and other examination maneuvers
are required. Flexor tendon lacerations can be identified by
observing a loss ofnormalfinger cascade. Injuries to theflexor
tendons can also be suggested by loss of tenodesis effect with
passive wrist extension and flexion. Another useful technique
to evaluate integrity of the flexor tendons can be compressing
the distal forearm that normally brings the fingers into the
flexed posture.
Diagnostic studies are occasionally helpful. Plain radio-
graphs, magnetic resonance imaging, or ultrasound may
help detect the location of the proximal tendon after closed
zone 1 injuries Gersey finger injury). Knowing the location of
the proximal tendon also assists in management. When the
Flexor Digitorum Profundis (FDP) retracts to the palm (Leddy
type 1), the tendon must be repaired within 2 weeks. When
retracted to the PIP joint, the repair must be performed within
6 weeks (Leddy type 2). When caught at A4 pulley (Leddy
type 3}, the repair can be performed at any time.s Fullness and
tenderness at these locations, ifpresent, direct management of
jersey finger injuries making diagnostic studies unnecessary.
The presence ofneurovascular injuries should also be assessed
for open lacerations at any level.
Partial tendon injuries are suggested in patients with pain
on resisted flexion. On exploration, if the injury is more than
60% of the tendon in diameter, it should be repaired. If the
injury is less than 60% oftendon diameter, the free edges are
debrided to prevent catching on the pulleys.'
TREAT!ffiNT
Ideal flexor tendon repairs are strong and smooth. Strength
allows for early active motion to prevent adhesion forma-
tion. Repairs should be strong enough to resist gap forma·
tion, which can be a site for adhesion formation or repair
rupture. Repair techniques should also be smooth and not
bunched to facilitate gliding of the tendons around adjacent
structures such as pulleys or other tendons. Repairing flexor
to the strength ofthe repair.
Recently, the modified Becker technique (MGH,
Massachusetts General Hospital) has gained popularity
for its strength, resistance to gap formation, and endurance
with active range of motion therapy.'-11 The MGH tech-
nique is like the Becker repair as it involves placement of
four strands through the core in a criss-cross configuration13
(Figures 77.3A-B). However, the MGH is different in that the
core sutures are 3-0 instead of 6-0 and includes augmentation
with an epitenon suture and avoids the step-cut bevel.
FIGURE77.3. TheMGI-lflexor teodon repairtedmique. (A)Thist!leh-
nique is like the 'Becker repair as it involves plaalmeD.t of four strands
throughthecoreinaaiss-crossconfiguration. (B). However,the modi-
fied Becka:n:clmique {MGH) isdifferentinthat theooresutlll:esare3-0
instEad of 6-0, and it includes augmentation with an epitenon sutlll:e,
avoiding thesll:p-c:ut BradenJ. Wilhelmi, :MD.(Wilhelmi 2014; Seiler III 2017)

17. 17
Moriya et al. Page 9
(Moriya et al 2010)
Menjahit Tendon (3)

18. Zone 1 - FDP
18
FIGURE 7-4
Distal zone of
vascularization
Interphalangeal
trans. digital a.
Proximal trans.
digital a.
Distal trans.
digital a.
Branch to VLS
VLS
VBS
VBP
Type 1 Type 2 Type 3a Type 3b
FIGURE 7-5
Type 1 Type 2 Type 3a Type 3b
Type 4a Type 4b Type 5a Type 5b
(Egeland et al 2012)

19. 19
Procedure 1 | Examination of the Hand and Wrist 1.e.9
Table 1-5 Classification of Flexor Digitorum Profundus (FDP)
Avulsion Injuries
Type 1 FDP retracted into palm
Type 2 FDP retracted to level of proximal interphalangeal (PIP) joint and is caught
at FDS chiasma (maybe associated with small chip fracture)
Type 3 FDP avulsed along with fragment of bone and is caught at A4 pulley
3A Fragment of bone is extra-articular
3B Fragment of bone is intra-articular
Type 4 FDP retracted into palm with associated fragment of bone
4A Fragment of bone is extra-articular
4B Fragment of bone is intra-articular
Type 5 FDP avulsed with fragment of bone and is caught at A4 pulley, and there
is an additional fracture of the shaft of distal phalanx
5A Fragment of bone is extra-articular
5B Fragment of bone is intra-articular
(Egeland et al 2012)

20. Rekonstruksi – Zone 1
• Stump FDP distal < 1 cm: tendon to bone repair
• Stump FDP distal > 1 cm: tenorrhaphy primer
(Wilhelmi 2014; Seiler III 2017)
20

21. 21
FIGURE 7-11
FIGURE 7-10
FIGURE 7-12
FIGURE 7-13
Feeding catheter
Flexor tendon
FIGURE 7-14
over the nail, the surgeon must observe
the tendon sitting securely within the
bone trough at the distal phalanx.
• The elevated periosteum can be sutured
to the end of the tendon using 4-0
Ethibond braided suture to provide
additional support.
FIGURE 7-15
Button
Flexor tendon
(Fig. 7-17).
᭿ Keith needle holes are drilled obliquely through the base of the distal phalan
just lateral or distal to the bone through to the dorsum of the finger whil
avoiding the germinal matrix of the nail.
᭿ The suture ends holding the distal aspect of the FDP tendon are then passe
thought the Keith needle holes to be withdrawn over the nail bed.
᭿ The sutures are then secured in place with a bolster, or button, on the dorsa
aspect of the finger (Fig. 7-18).
(Egeland et al 2012)

22. Rekonstruksi – Zone 1 Post Op
• Splint dorsal: fleksi wrist 600 dan sendi MCP 900
• Splint dipertahankan 4 minggu dan latihan fleksi –
ekstensi pasif dimulai pada sendi DIP dalam satu
minggu
• Setelah 4 minggu, splint secara gradual
diekstensikan, mulai latihan fleksi aktif ringan
• Kancing dan jahitan dilepas 8 minggu post op
• Tiga bulan setelah repair, mulai:
– Latihan penguatan
– Massage pada parut luka
(Egeland et al 2012)
22

23. Rekonstruksi – Zone 2
• Jahitan core:
– Tipe dan kaliber benang
– Jumlah strand
• Jahitan epitendon:
– Sirkumferensial, menambah kekuatan jahitan
– Adjunct terhadap jahitan core
• Pembentukan gap:
– Canine study: 3 mm
(Seiler III 2017)
23

24. 24
FIGURE 8-10
A5 C3 A4 C2 A3 C1 A2 A1 A5 C3 A4 C2 A3 C1 A2 A1
Tendon laceration
Tendon laceration
Tendon laceration
Tendon laceration Sheath-pulley release
Sheath-pulley release
Sheath-pulley release
Sheath-pulley release
(Egeland et al 2012)

25. Rekonstruksi –
Zone 2
25
᭿ If both these maneuvers do not work, the method described by Sourmelis and
McGrouther should be tried. A chevron incision is made in the distal palm
proximal to the A1 pulley.The flexor tendons are identified. If they are still within
the A1/A2 pulley, they are not disturbed. A 5/6 French pediatric feeding tube is
passed from retrograde through the flexor sheath to emerge at the proximal
incision. The feeding tube is sutured to the palmar surface of the flexor tendon
without withdrawing the tendons from the fibrous flexor sheath. If the tendon
ends have retracted proximal to the A1 pulley, the feeding tube is sutured to
the end of the tendons. Using a combination of pulling the feeding tube at the
distal incision and pushing the flexor tendon at the proximal incision,the tendon
ends are delivered into laceration (Fig. 8-11).
᭿ After retrieval to the site of repair, the tendon should be secured in place with
a hypodermic needle to prevent it from retracting proximally and to allow a
tension-free repair.
FIGURE 8-10
Tendon laceration
Tendon laceration Sheath-pulley release
Sheath-pulley release
Catheter
Open wound
with catheter
Suture
Flexor
tendon
FIGURE 8-13
Locking
outer core
CircumferentialHorizontal
mattress
inner core
substance. One should ther
the tendon at first pass.A m
of the tendon is grasped by
making the transverse port
᭿ A horizontal mattress sutur
4-0 Ethibond. Approximate
longitudinal portion of the
(Fig. 8-15).
᭿ The palmar half of the epit
FIGURE 8-14
Outer-core locking suture
FIGURE 8
Procedure 8 | Acute Repair of Zone 2 Flexor Tendon Injury 71
᭿ Next a modified Kessler core suture is placed in the standard manner (Fig. 8-14).
The transverse portion of the suture is locked. It is important to remember that
3-0 Ethibond is a braided suture and does not glide well within the tendon
substance. One should therefore pull the required length of the suture through
the tendon at first pass.A minimum of 0.7 cm, and most commonly 1 to 1.2 cm,
of the tendon is grasped by the longitudinal portion of the suture loop before
making the transverse portion.
᭿ A horizontal mattress suture is placed within the previous suture repair using
4-0 Ethibond. Approximately 0.5 to 0.6 cm of the tendon is grapsed by the
longitudinal portion of the suture loop before making the transverse portion
(Fig. 8-15).
᭿ The palmar half of the epitendonous repair is now completed (Fig. 8-16).
Outer-core locking suture Horizontal mattress inner-core suture
(Egeland et al 2012)

26. Rekonstruksi – Zone 2 Post Op
• Splint fleksi wrist joint 300, fleksi MCP 600, jari-jari slight
flexion
• Hari 3: dorsal blocking splint (DBS) fleksi wrist joint 200, fleksi
MCP 700, jari-jari netral
– Setiap 2 jam: fleksi – ekstensi pasif DIP, PIP, dan seluruh jari,
setiap sesi 25 repetisi
– Splint tenodesis: memungkinkan ekstensi wrist joint sampai
300, fleksi pasif jari sambil ekstensikan wrist joint.
– Setelah ekstensi, kepalkan jadi 5 detik, lalu rileks secara pasif
sambil mengembalikan wrist joint kembali fleksi
(Egeland et al 2012) 26

27. 27
Procedure 8 | Acute Repair of Zone 2 Flexor Tendon Injury
FIGURE 8-18
0 weeks 1 week 3 weeks 6 weeks
0
Newtons
Index pinch
Strong grip
Light active
6-Strand
4-Strand
2-Strand
Passive motion
140
120
100
80
60
40
20
(Egeland et al 2012)

28. 28
A
B
C
D
FIGURE 6.16 Controlled passive motion method. A, Orthoplast dorsal blocking splint is used to hold wrist in mild flexion, MP joints in
(Seiler III 2017)

29. 29 (Seiler III 2017)
A B
C
D
URE 6.17 Controlled place-and-hold motion after flexor tendon repair protocol. A, After removal of the surgical bandage, a traditiona
blocking splint that positions the wrist in 20 degrees of palmar flexion, MP joints in 50 degrees of flexion, and IP joints in extension
n of PIP joint. D, Full passive flexion of MP, PIP, and DIP joints.

30. Rekonstruksi – Zone 2 Post Op
• Minggu 4
– Lepas splint tenodesis
– Kepalkan tangan dalam posisi netral pada wrist joint
– Fleksi dan ekstensi aktif pada wrist joint
• Minggu 5: ekstensi aktif
• Minggu 6: lepas DBS, buddy taping, splint ekstensi dipakai saat
malam
• Minggu 8: latihan kekuatan dimulai
• Minggu 10-12: pasien kembali ke rutinitas, tanpa angkat beban
berat
(Egeland et al 2012)
30

31. Rekonstruksi – Zone 3, 4, 5
• Prinsip sama dengan zone 2
• Urutan:
– Ekspose semua luka
– Debridement
– Identifikasi struktur yang putus
– Repair struktur yang terputus
• Perhatikan kemungkinan cedera saraf dan vaskuler
(Wilhelmi 2014; Seiler III 2017)
31

32. Memakai Benang Apa?
32
Original Article The Journal of Hand Surgery (Asian-Pacific Volume) 2018;23(2):243-247 • DOI: 10.1142/S2424835518500285
The Effect of Suture Materials on the Biomechanical
Performance of Different Flexor Tendon Repairs
and the Concept of Construct Efficiency
Yoke Wong Rung*, Austin Mun Kitt Loke*, Shian Chao Tay*,†
*Biomechanics Laboratory, Singapore General Hospital,
†
Department of Hand Surgery, Singapore General Hospital, Singapore
Background: To propose a new term (‘construct efficiency’) for the evaluation of multi strands flexor tendon repairs using differ-
ent suture materials.
Studi in vitro: benang braided polyblend lebih superior dibandingkan
dengan benang nilon dalam hal kekuatan. Kekuatan 4 strand dan 6
strand tidak berbeda signifikan dalam hal kekuatan.

33. Faktor Kontributor Output
33
Selain jumlah strand, tipe jahitan, dan ukuran benang, asimetri juga
menentukan kekuatan repair dan pencegahan timbulnya gap. Fibrin glue
sama baiknya dengan jahitan epitenon dengan gliding yang lebih baik.
Pilihan OAINS: ibuprofen. Masa depan: TGF-β, NF-κβ, dan VEGF.
Flexor Tendon Repair
Healing, Biomechanics, and Suture
Configurations
Christopher Myer, MD, John R. Fowler, MD*
KEYWORDS
Flexor tendon Suture configuration Biomechanics Growth factors Biological augmentation
KEY POINTS
Tendon healing is a complex process that must coordinate healing within the tendon while limiting
the amount of fibrosis in the surrounding tissues.
The ultimate goal of surgical intervention has remained constant: to achieve enough strength to
allow early motion, to prevent adhesions within the tendon sheath, and to restore the finger to
normal range of motion and function.
The ultimate goal of surgical intervention has
mained constant: to achieve enough strength
allow early motion, to prevent adhesions wit
the tendon sheath, and to restore the finger
normal range of motion and function. In rec
years, basic science research has focused
biological factors that will increase the tend
Department of Orthopaedics, University of Pitts
Pittsburgh, PA 15213, USA
* Corresponding author.
E-mail address: johnfowler10@gmail.com
Orthop Clin N Am 47 (2016) 219–226
http://dx.doi.org/10.1016/j.ocl.2015.08.019
0030-5898/16/$ – see front matter Ó 2016 Elsevie

34. Bagaimana di Asia?
34
Strong Digital Flexor
Tendon Repair, Extension-
Flexion Test, and Early Active
Flexion: Experience in 300 Tendons
Jin Bo Tang, MDa,
*, Xiang Zhou, MDb
, Zhang Jun Pan, MDc
,
Jun Qing, MDb
, Ke Tong Gong, MDd
, Jing Chen, MDa
KEYWORDS
Flexor tendon Multistrand repair Digital extension-flexion test Early active motion
KEY POINTS
Over the past 2 decades, repair and rehabili
methods of primary repair of the digital
tendon have changed. Key techniques deve
over this period include strong tendon
methods (typically multistrand), venting o
critical pulleys, an intraoperative
extension-flexion test of repair quality, and
postoperative active motion.1–5
Improveme
repair outcomes have been demonstrate
hand centers with a history of tendon-re
research.6–8
However, improved outcome
a
Department of Hand Surgery, The Hand Surg
Nantong, Jiangsu, China; b
Department of
c
Department of Surgery, Yixing People’s Ho
Tianjing Hospital, Tianjing, China
* Corresponding author. Department of Hand
of Nantong University, 20 West Temple Road,
E-mail address: jinbotang@yahoo.com
Hand Clin 33 (2017) 455–463
http://dx.doi.org/10.1016/j.hcl.2017.04.012
0749-0712/17/Ó 2017 Elsevier Inc. All rights res

35. Bagaimana di Asia? (2)
• Repair site menjadi lebih bulky
• Venting pada puli dan sheath dapat sampai 2,5 cm tanpa
bowstringing
• Pergerakan dini tanpa splint pada minggu 1-2;
perhatikan: jari yang bengkak dan resistensi gerakan à
posisi wrist tak lagi penting
• FDS tidak diperbaiki: tidak ada adverse outcomes
• Tension pada repair site diikuti tes fleksi-ekstensi
durante operasi lebih kritis daripada menjaga repair site
tetap smooth
(Tang et al 2017)
35

36. Komplikasi
36

37. Komplikasi
• Adhesi
– Minimalkan diseksi tendon
– Early mobilization
– Imobilisasi dengan gips meningkatkan risiko
• Ruptur
– Kekuatan repair menurun 50% antara minggu pertama dan
ketiga bila tendon tidak diregangkan
– Non komplians
• Lain-lain:
– Infeksi, nekrosis pada flap kulit
(Wilhelmi 2014)
37

38. 38
RESEARCH ARTICLE
Experimental study of tendon sheath repair
via decellularized amnion to prevent tendon
adhesion
Chunjie Liu1,2
, Kunlun Yu2
, Jiangbo Bai2
, Dehu TianID
2
*, Guoli Liu3
1 Department of Orthopedics, Tangshan Workers Hospital, Tangshan City, Hebei Province, P. R. China,
2 Department of Hand Surgery, The Third Affiliated Hospital Of Hebei Medical University, Shijiazhuang,
Hebei Province, P. R. China, 3 Department of Orthopedics, The Second Hospital Of Tangshan, Tangshan
City Hebei Province, P. R. China
* tiandehu_1961@126.com
Abstract
The adhesion of tendon and surrounding tissue is the most common complication after
repairing an injured tendon. The injured flexor tendons in zone II are frequently accompa-
nied by tendon sheath defects, which lead to poor recovery. A variety of biological and non-
a1111111111
a1111111111
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a1111111111
a1111111111
* tiandehu_1961@126.com
Abstract
The adhesion of tendon and surrounding tissue is the most common complication afte
repairing an injured tendon. The injured flexor tendons in zone II are frequently accomp
nied by tendon sheath defects, which lead to poor recovery. A variety of biological and
biological materials have been recently used for repair or as substitute for tendon shea
prevent tendon adhesion. However, non-biological materials, such as polyethylene film
have been used to prevent tendon adhesions by mechanical isolation. The possibility o
don necrosis and permanent foreign body remains due to the lack of permeability and
obstruction of nutrient infiltration. The natural macromolecule amniotic membrane deri
from organisms is a semi-permeable membrane with the following characteristics: smo
without vascular, nerve, and lymphatic; and rich in matrix, cytokines, enzymes, and oth
active ingredients. The unique structure of this membrane makes it an ideal biomateria
the experiment in Henry chicken, the model of tendon sheath defect and the flexor digi
tendon in zone II was established and randomly divided into control group, medical me
brane group, and decellularized amniotic membrane group. Samples were obtained at
2nd, 4th, 8th, and 12th week after operation. General, histological, and biomechanical
were performed to investigate the preventive effect of repaired tendon sheath by decal
ized amniotic membrane. Experimental results showed the following: the amniotic mem
brane group and the medical membrane group had mild inflammatory reaction and tiss
edema, and nearly no adhesion was observed in the surrounding tissue; the fibroblast-
a1111111111
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OPEN ACCESS
Citation: Liu C, Yu K, Bai J, Tian D, Liu G (2018)
Experimental study of tendon sheath repair via
decellularized amnion to prevent tendon adhesion.
PLoS ONE 13(10): e0205811. https://doi.org/
10.1371/journal.pone.0205811
Editor: Chunfeng Zhao, Mayo Clinic Minnesota,
UNITED STATES
Received: May 8, 2018
Accepted: October 2, 2018
Published: October 16, 2018
Copyright: © 2018 Liu et al. This is an open access
article distributed under the terms of the Creative
Commons Attribution License, which permits
Pada model ayam: pemberian amnion dapat memperbaiki struktur tendon
sheath, tidak mengurangi kekuatan, mengurangi adhesi, dan
memungkinkan gliding yang lebih baik daripada kelompok kontrol.

39. Kesimpulan
39

40. Kesimpulan
Untuk mencapai hasil optimal pada perlukaan tendon
fleksor tangan:
• Kasus perlukaan pada tendon fleksor memerlukan
repair yang teliti karena sangat menentukan outcome
• Tiap zone memiliki karakteristik dan tantangan repair
tersendiri
• Jahitan pada tendon: core dan sirkumferensial saling
memperkuat
• Mobilisasi sendi baik pada jari maupun tangan
dilakukan dini, terencana, dan akurat
40

41. Referensi – Buku Teks
Egeland BM, Sebastin SJ, Chung K. 2012. Acute Repair of Zone 1 Flexor Digitorum
Profundus Avulsion dalam Chung K (Ed.) Hand and Wrist Surgery 2nd Edition.
Elsevier. Philadelphia.
Egeland BM, Sebastin SJ, Chung K. 2012. Acute Repair of Zone 2 Flexor Digitorum
Profundus Avulsion dalam Chung K (Ed.) Hand and Wrist Surgery 2nd Edition.
Elsevier. Philadelphia.
Seiler III GJ. 2017. Flexor Tendon Injury dalam Wolfe SW, Hotchkiss RN, Pederson
WC, Kozin SH, Cohen MS (Eds.) Greens Operative Hand Surgery Seventh
Edition. Elsevier. Philadelphia.
Standring S. (Ed). 2005. Gray’s Anatomy: The Anatomical Basis of Clinical Practice.
Elsevier Churchill Livingstone
Wilhelmi BJ. 2014. Flexor Tendon Repair dalam Chung KC, Gosain A, Gurtner GC,
Mehrara BJ, Rubin JP, Spear SL (Eds). Grabb Smith’s Plastic Surgery 7th
Edition. Lippincott Williams Wilkins. Philadelphia.
Zidel P. 2007. Tendon Healing and Flexor Tendon Surgery dalam Thorne CH, Beasly
RW, Aston SJ, Bartlett SP, Gurtner GC, Spear SL (Eds.) Grabb Smith’s Plastic
Surgery 6th Edition. Lippincott Williams Wilkins. Philadelphia.
41

42. Referensi – Jurnal
Kannus P. Structure of the tendon connective tissue. Scand J Med Sci Sports 2000: 10: 312–
320
Liu C. Yu K. Bai J. Tian D. Liu G. Experimental study of tendon sheath repair via
decellularized amnion to prevent tendon adhesion. PLoS ONE 13(10): e0205811
Moriya T. Zhao C. An KN, Amadio PC. The Effect of Epitendinous Suture Technique on
Gliding Resistance During Cyclic Motion After Flexor Tendon Repair: A Cadaveric
Study. J Hand Surg Am. 2010:35(4): 552–558
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“My hands are small, I know, but they’re not yours, they are my own. And I’m
never broken. We are God’s hands…”
- Jewel
Terima Kasih