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Great suggestion! We will probably re-do this video with other techniques as well.

Glad it was helpful!

Hi, it’s simply skipped moving the needle from the left to the right and pulling the suture, as it was the same bites repeating to save time in the video.

Please upload any other cases you do esp tendon repairs, nerve repairs, tenosynovitis debridements, deformity corrections. At the institution I work at we don’t have a plastics consultant so often we just read and try our best. These videos are really really helpful.

Thank you for your comment. The nail even if sutured gets stuck on to the remaining nail bed, and doesn’t have to be removed. New nail will grow from the eponychial fold and push the old nail out(just like shown at the end of the video), so you have to warn the patient it will look add for a few months and to keep trimming until the new nail completely covers the nail bed.

Yea Jelonet will be fine, but you can’t leave jelonet for that long as the paraffin dries up and it will be very stuck, so if you use jelonet then change the dressing sooner at 1 week.

🙏 thank you

That’s right, the needle is tapered, makes it sharp and good for debriding bone.

The biological material is rind/fat of a pork chop that’s been boiled to soften it. The hollow clear tube is the sleeve that comes on the top of a pair of suture or tenotomy scissors.

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👍

You’re welcome 😊

Coming soon!

It’s a great party trick, and a good adjunct, but in isolation shouldn’t affect your decision about surgery. We try in on our residents and it is positive in a lot of people with subclinical nerve compression.

Glad it’s helping!

You’re welcome

You’re welcome!

If it is detected early, sometimes splints and conservative treatment can help. It is important to recognise the cause and your doctor can help you with the most appropriate treatment.

Glad we’re on the same page!

Usually after that long you would need a 2-stage reconstruction or a tendon transfer.

@@sharpnsurgery aghh.. I will look into this! Thank you so much!

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Hi and thank you. We are unable to give medical advice on RUclips regarding your child unfortunately, but in general the main question in the ankle you have to ask your doctor is which specific tendon has been injured, what function is lost and do the risks of surgery and anesthesia outweigh the benefits of repair.

Thank you so much . they did not mentioned anything just said this need a surgery to fix and did not had any mri of her foot just done an xray and examine her foot her foot n finger can move downward but she has to struggle to lift her thumb

@@sharpnsurgery tendon can recover without surgery ?is it important to go for surgery

There would be no tendon left at that point unfortunately.

Thank you, the epitendinous suture is actually an adjunct to the core suture which could be a Kessler, they are not used independent of each other. The epitendinous suture adds around 30% to the strength of your repair, and only really needs to be used in flexors distal to zone V.

@@sharpnsurgery Oh great. Thanks for this reply. For epitendinous sutures I have hitherto used simple or continuous 5/0 or 6/0 prolene sutures, but will try this technique next time.

​@@kendaddi5857 yes we would usually use a 5-0, maybe 6-0 in a little finger flexor or child. The continuous epitendinous is just as good and actually like you say has less suture foreign material reaction and might be better than the silferskiold according to more recent studies, so it's fine to stick to a continuous epitendinous suture.

There is always a place for newer minimal access techniques, and we do them as well, but patient selection is important. As a specialist nerve surgery unit, we also see all the complications from these newer minimal access procedures that haven't been around long enough to have obtained enough of a safety profile, and risking the possibilities of nerve pain for life for short term quicker recovery is a choice not everyone might want to make as the outcome at 3 months are the same for both procedures. There are also a lot of places which might not be able to afford the newer technologies.

Glad you think so!

Thank you!

Youre welcome!

Thanks

You will have to gradually do it, and elevate your hand as much as you can to reduce the swelling and then you can mobilise more. Consult your doctor if you are having problems as issues like Complex Regional Pain Syndrome should be identified and treated early.

You're welcome!

Not if you are a good distance away which you will be if you're on the scalp, and if you raise the flap completely so that it rotates instead of advances. And the burrows triangle or back cut further takes tension off the eyebrow, but you're right, one will have to be aware of the eyebrow and tailor your flap to protect it from disruption so very good question.

Glad it was helpful!

Thanks!

Thank you for your question. The short answer is yes, they heal and "re seal" themselves through intrinsic and extrinsic means. The sutures provide strength while they heal so that the ends are approximated and rehabilitation and moving the tendon is possible to prevent adhesions and stiffness. The tendon is fully healed to around 80% of the original strength at 12 weeks and the patient can return to all previous activity. At this point if you were to (hypothetically) do an operation to cut and remove the sutures, it would make no difference to the integrity of the tendon.

Thank you

Thanks!

Brilliant

Hi, the suture that was used to repair your tendon was likely the blue suture you see, which is usually non-dissolvable. The tendon is fully healed in 3 months, so 13 years down the line if you remove the suture it shouldn't cause any problems, but yes a surgeon would be able to remove your suture for you if it is extruding/showing now.

@@sharpnsurgery Thank you for your answer, but I don't remember getting stitches on my tendon. I feel a bulge when I touch the tendon. Does that mean there's a seam there? So the glass was on my arm. The tendon in my arm remained as it was, that is, the glass did not cut the tendon, but in such a case, does the tendon still need to be stitched again?

Yes of course!

Hi, the sutures are being demonstrated on pig fat, it is the rind/fat of a piece of pork chop which has been cut in half. The hollow plastic tube is just the protective tube that comes with disposable forceps/scissors to protect the tip.

Essentially yes, under the sutures of the longitudinal bites, watch the hollow tube part under common errors to see how it looks like from the side.

Glad it was helpful!

Will try our best!

Hi, the tendons in the hand are different to the knee tendons. A repaired flexor tendon will only get back to being about 80% as strong as it was structurally, although this will not be obvious clinically and one should be able to regain full power. The recovery is slow the tendon is weakest from 1-2 weeks after repair, then gets stronger up to 8 weeks when splints are usually discontinued and only applied at night and full recovery is complete at 12 weeks, where return to full activity, heavy lifting and contact sports can be resumed. The knee tendon, will be different and might have a longer rehabilitation period depending on which tendon is cut.

@@sharpnsurgery Thank you very much. My tendon below my knee was cut a lot with ceramic cutter glander, the day after the cut I had surgery to attach it then put 42 pins in the upper part now how long will it take to heal and after how long can I join heavy work please Please let me know if I do any heavy work before the scheduled time, is there a risk of tearing the tendons that have been reattached?

Hi, you will have to ask your treating surgeon for that advice, as said before knee tendons are very different to hand tendons.

@@sharpnsurgery If I ask the person who is doing the surgery or to meet him, it takes 30 thousand in Bangladeshi taka because I am in Saudi Arabia and at the moment I don't have any money to ask him. So I asked you if I could know anything, it would be helpful. I am 24 years old. And now I am unemployed after the operation, all the money I had was spent on the operation, so I can no longer go to the doctor

Thank you!

You’re welcome

You're so welcome!

Thank you for your kind words.

100% agree. I’m doing the exercises and progressing well.

Thank you 🙏

Thanks

Dear Chill Dudie, It's unlikely you have had a tendon repair if they didn't use sutures. More likely you have had a laceration with no tendon injury but the healing has caused scarring which has stuck to the tendons a little bit and it is tight when you close your fist because it pulls on the tight scarred area. The initial treatment for this is physio therapy and if still a problem surgery to release the scarring and adhesions.

Thank you 🙏