Mảnh này được coi là ổn định với một loạt các chuyển động. Đồ ép cho máu cầm lại được xì hơi, cầm máu thu được, và dung dịch muối thủy lợi thực hiện. Da được đóng cửa với chỉ khâu nylon 4-0 đơn giản, thay đồ cồng kềnh áp dụng, và ngăn chặn các thanh nẹp lưng áp dụng với cổ tay | TENDON INJURIES A Figure 36 4. A . Lateral radiograph and B . a radiograph of a type 3 avulsion secured with two cortical screws. were placed with bicortical purchase Fig. 36 4 . The fragment was seen to be stable with a range of motion. The tourniquet was deflated hemostasis obtained and saline irrigation performed. The skin was closed with 4 0 nylon simple sutures a bulky dressing applied and a dorsal blocking splint applied with the wrist in 30 degrees of flexion. The fingers were splinted in the intrinsic-plus position to relax the FDP tendon and prevent postoperative stiffness. Type 1 and 2 injuries necessitate exploration at the level of the PIP joint where an additional palmar zigzag incision is used to expose the flexor sheath Fig. 36 3 . A transverse incision is made into the sheath just distal to the A2 pulley or through the C1 pulley. If the FDP tendon is not found at this level then an additional incision is made in the palm and the flexor sheath is opened proximal to the A1 pulley. If the tendon is found at this level it is classified a type 1 injury. The long and short vincula are ruptured and the blood supply to the tendon is theoretically compromised. The tendon is retracted proximal to the flexor sheath preventing this source of nutrition via intrasynovial diffusion. This necessitates earlier repair within 7 to 10 days to prevent possible necrosis and myostatic contracture that may develop. A 4 0 Prolene suture is placed as a core suture in the proximal tendon stump. An infant feeding gastrostomy tube or Swanson suture passer is placed in retrograde fashion from just distal to the A2 pulley at the PIP level incision through the flexor sheath. Care is taken to place the tube suture passer through the flexor superficialis decussation and to exit proximal to the A1 pulley. The tube suture passer is attached to the core suture and the tendon is pulled distally to the level of the PIP joint. Next the tube suture passer is fed retrograde under A4 from .
