Amir Labib is a plastic surgery resident at Ain Shams University Hospitals. The document discusses factors that affect flexor tendon repair strength and different rehabilitation methods. It notes that early mobilization after 1970s was found to allow intrinsic tendon healing capacity. Rehabilitation protocols aim to balance adhesion risk reduction through early motion with rupture prevention using immobilization. The document recommends at least a 4-strand repair and considering all elements to maximize strength for early active mobilization protocols.

1. Amir Labib
Plastic surgery resident, Ain Shams
university Hospitals

2.  Anatomy and nutrition of flexor tendons.
 Tendon healing and biomechanics.
 Factors affect surgical repair strength.
 Different methods of rehabilitation.

6.  Early inflammation
 Cellular proliferation:
1970s : intrinsic tendon healing capacity….early
mobilization
 Remodeling
• Extrinsic healing
• Intrinsic healing
No…filmy…loose…moderate…dense

10.  Children
 Non compliant
 Any contraindication for early mobilization:
e.g. replantation cases, fracture with unstable
fixation.

11. Wrist: 30 degree flexion
MPJ: 50- 70 degree flexion
IPJ: fully extended
3rd- 4th week: wrist extended
6th week: remove the splint

12.  Wrist: 20 degree flexion
 MPJ: 50 degree flexion
 IPJ: fully extended
Pros:
• Better differential gliding
• Less PIP flexion deformity
Cons:
Greater tension on repair site

13.  At least 4 strand
repair
Tenodesis splint

16.  Tendon immobilization protocols have
increased risk of adhesions.
 Early active rehabilitation protocols have
lower risk of adhesions, but higher rupture rate
than early passive rehabilitation
 For early active mobilization: at least 4 strand
repair.
 All elements to increase tendon repair strength
should be considered.

17. 1. Neligan, P. Plastic Surgery (hand and upper
extremity). (Elsevier, 2013).
2. Starr, H. M., Snoddy, M., Hammond, K. E. &
Seiler, J. G. Flexor tendon repair rehabilitation
protocols: A systematic review. J. Hand Surg.
Am. 38, (2013).
3. Mohammed Aljodah. Hand rehabilitation after
flexor tendon repair. 10–47 (2015).