Vật lý trị liệu bắt đầu vào cuối của tuần 4 với mục đích để kích thích lưu thông hydrotherapy và xoa bóp các cơ bắp flexor và duy trì tính di động thụ động của các khớp ngón tay. Nhiễm trùng là nguyên nhân phổ biến nhất của sự thất bại trong loạt Boyes | 92 Bindra tures in them. Physical therapy began at the end of wk 4 with the purpose to stimulate circulation by hydrotherapy and massage of the flexor muscle and to maintain passive mobility of the finger joints. Infection was the most common cause of failure in Boyes series of primary digital flexor tendon repair published in 1947 14 followed by adhesion of the repaired digital flexor tendons in what he called the critical zone. The third cause of failure was complications from poorly placed surgical incisions. Using Bunnell s techniques he recommended exposure by midlateral incisions in the digits with additional transverse incisions in the palm. He suggested primary tendon repair only in those cases in which the wound was sharp of short duration and without any accompanying fractures or soft tissue damage. In these ideal conditions Boyes recommended removal of the sub-limis down to its insertion and repair of the profundus tendon alone. He advocated removal of the sheath overlying the repair and a lateral release of the pulleys to relieve tension and prevent ischemic necrosis of the tendon ends. If conditions were less than ideal the wound was closed primarily after the excision of devitalized tissue. Joint motion was maintained passively with a plan to return for a delayed repair of the tendons 3 or 4 wk later using the Bunnell method of suture at a distance with fine interrupted sutures at the repair site and stainless steel wire pullout placed proximally in the palm. In 1947 Littler reported successful management of flexor tendon injuries by reconstruction with a free graft 15 . His principles for successful tendon grafting were 1 excision of the entire fibrous flexor sheath except for the pulleys at the base of the proximal and middle phalanges 2 use of a Bunnell stainless steel pullout suture for the distal juncture and a silk or nylon Bunnell suture at the proximal juncture in the palm and 3 suturing the graft at the lumbrical level in the palm and .
