Depending on the nature of your injury you may be given antibiotics and/or a tetanus jab before surgery to prevent your hand becoming infected. Tendon repair is not usually regarded as emergency surgery, but is generally carried out as quickly as possible after the injury, usually within a few days. This is because the longer the tendons remain ruptured, the more scarring will develop on the end of the tendons. This could reduce the range of your hand movement after surgery.
Extensor Tendon Repair
Extensor tendon repair is usually carried out either under a regional or a general anaesthetic. Regional anaesthetic is injected into the base of the neck or the top of the shoulder to numb the whole arm. If your tendon was damaged as the result of a wound, the wound will be thoroughly cleaned. A cut (incision) may be made in your hand to make the wound larger and the two ends of the ruptured tendon will be stitched together. The wound will be closed with stitches and a rigid splint (a support to protect your hand) made of plaster will usually be fitted to stop you moving your hand and damaging the repaired tendons.
If nothing else has been damaged, extensor tendon repair surgery can take around 30 minutes to complete.
Flexor Tendon Repair
Flexor tendon repair usually needs to be carried out under either general anaesthetic or regional anaesthetic (where the whole arm is numbed). A tourniquet will be wrapped around your upper arm to stop the blood circulating so that bleeding at the wound doesn't make it difficult to see the relevant structures. A tourniquet is a cord or tight bandage that's used to squeeze the arm and temporarily cut off the blood supply. The surgeon will then extend the wound, or make an incision if there's no wound, to locate the damaged tendons. He will bring the two ends of the damaged tendon together before stitching them to each other.
The wound in the hand will be closed with stitches and a rigid plaster splint will usually be applied to protect the repaired tendons. A simple flexor tendon repair takes 45 to 60 minutes, but complex surgery for more severe injuries could take much longer.
It's normal for your hand to be elevated in a sling to help reduce swelling. Following the operation, your hand is likely to be bruised and swollen and, when the anaesthetic wears off, it'll be painful. You may need to take painkillers, such as ibuprofen, paracetamol or codeine, for up to two weeks post operation.
Before leaving hospital, you may be advised to raise your arm on cushions while seated or to hold your arm up to your other shoulder while standing and walking. You won't be able to drive for several weeks after the operation.
The stitches will be removed by the outpatient nurses ten days post operation.
You will be referred to see a specialist hand physiotherapist who will advise you to wear the splint at all times for three to six weeks, possibly followed by just wearing it at night for a further couple of weeks. Your hand therapist will tell you how to look after your splint and what to do if you develop any problems with it. You will be taught a number of different hand exercises after the operation. The exercises will help prevent the repaired tendons getting stuck to surrounding tissue, which would reduce your range of hand movements. The specific exercises recommended by your hand therapist will vary according to the type of tendon repair you had.
You will see your surgeon in clinic six weeks' post operation.