Surgical Approaches and Steps
Pradeep Venkatesh in Handbook of Vitreoretinal Surgery, 2023
Tenotomy is the surgical step of incising the tenons capsule [and intermuscular septa] to gain access to the muscle insertion and scleral surface [Figure 9.2]. This is followed by bridling the recti muscles [see section on surgical anatomy], taking precautions to not split the muscle, the muscular arteries, and fibres of the superior and inferior oblique [Figure 9.3]. Thick cotton thread or silk suture could be used to for this purpose. Bridle suture must be about 10 cm in length [after doubling] and is knotted proximally at about 10 mm from the muscle insertion and distally close to the ends of the suture. Knots at about 10 mm from the muscle insertion allow the surgeon to have better control on the muscles, thereby allowing precise globe rotation and preventing sudden slippage [while passing scleral sutures].
Review of literature
R. L. Mittal in Clubfoot, 2018
MacNeille et al.16 reported a mini open tendoachilles lengthening in view of many complications due to closed heel cord cutting, considering its necessity in over 85% of cases and to avoid the complications. The complications of closed tenotomy, which have been reported in the literature, are bleeding due to injury to the peroneal artery, the posterior tibial artery, or the lesser saphenous vein; injury to the posterior tibial or sural nerve, and incomplete release. More rare complications reported many times in the literature and also quoted by these authors (Changulani et al. 2007) are congenital vascular anomalies and the absence of the anterior tibial and/or posterior tibial artery, with the peroneal artery assuming prominent arterial supply, and serious neurovascular damage by closed tenotomy. The authors conducted 63 tenotomies (41 patients) in the operating room, in children 5–48 weeks of age, with an average age of 12.5 weeks, through a 10 mm incision on the medial edge of the tendoachilles under vision, and all the complications mentioned were avoided.
Surgery of the Hand
Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou in Operative Orthopaedics, 2020
In the thumb, the proximal border of the A1 pulley is at the level of the proximal digital skin crease over the MCP joint. A 1–1.5 cm transverse incision is created in the crease. Tenotomy scissors are used for blunt dissection through the subcutaneous fat and palmar fascia to expose the FPL tendon sheath and A1 pulley. The digital nerves and vessels running parallel to the FPL tendon are identified and protected with right-angle retractors. The A1 pulley is identified, and the radial attachment of the pulley is divided completely with a scalpel from proximal to distal. The thumb is then flexed and extended several times to test for any residual triggering. Any tourniquet is released and haemostasis is achieved. The wound is washed out with saline before closure.
The challenges faced by clinicians diagnosing and treating infantile nystagmus Part II: treatment
Published in Expert Review of Ophthalmology, 2021
Eleni Papageorgiou, Katerina Lazari, Irene Gottlob
The four-muscle tenotomy is another procedure used in the surgical treatment of nystagmus and involves detaching and reattaching the rectus muscles at their insertion [111]. Tenotomy includes the removal of the tendon organs responsible for proprioception, and hence the nystagmus is reduced and the null region is broadened [113]. This procedure can be applied on both horizontal and vertical muscles and can be combined with strabismus correction. Hertle et al. reported a series of 75 patients with congenital nystagmus, who underwent either recess/resect surgery or tenotomy [114]. There was a postoperative improvement of 0.1 logMar in VA in 71% of patients and a significant improvement in null zone width. Other studies have also described improvement in foveation characteristics and small VA gains, but only a few individual patients had VA improvement that exceeded test–retest variability [115–117]. Hence, the efficacy of four-muscle tenotomy has yet to be determined in larger-scale studies.
Brugada syndrome and the story of Dave
Published in Neuropsychological Rehabilitation, 2018
Samira Kashinath Dhamapurkar, Barbara A Wilson, Anita Rose, Gerhard Florschutz
Dave was hypersensitive to touch which interfered with his skin hygiene. Desensitisation (graded tactile sensory stimulation) techniques helped to manage his hand hygiene. He was also prescribed lorazepam only prior to cutting his fingernails or taking blood samples. His behaviours were controlled with twice a day dose of clonazepam and making sure familiar staff were on duty. Later on, tenotomy (the division of flexor tendons) was performed to maintain skin hygiene and to prevent him from developing painful ulceration from his nails digging into his palms. Although this operation could potentially prevent him from using his fingers, it was considered to be in his best interests as he was not engaging in functional tasks and, due to severe hypoxic brain injury, the likelihood of any recovery was minimal.
Arthroscopic knotless tape bridging with autologous platelet-rich fibrin gel augmentation: functional and structural results
Published in The Physician and Sportsmedicine, 2019
Ruben Dukan, Aude Bommier, Marc-Antoine Rousseau, Patrick Boyer
All the procedures were performed in the beach chair position with a scalene block and sedation. Arthroscopic exploration was completed using a 30° arthroscope through a standard posterior portal and an arthroscopic pump maintaining a pressure of 50 mmHg. Standard anterior and lateral portals were introduced via an outside-in technique. Systematic gleno-humeral joint and sub-acromial exploration were performed, and lesions were managed as necessary. After arthroscopic debridement of the lesion, rotator cuff tear was evaluated, numbers of involved tendons, visual tendon grade, excursion, and presence of subscapularis tear were documented. Tenotomy or tenodesis was undertaken in case of lesion. In most cases an acromioplasty with bursectomy was performed, with an abrasion of the footprint in all cases. If the tear was reducible with the grasper arthroscopic repair was done. Rotator cuff repair was performed to cover the original footprint using a knotless tape-bridging technique [12]. See Figures 4–5
Related Knowledge Centers
- Achilles Tendon
- Clubfoot
- Tendon
- Cerebral Palsy
- Hammer Toe
- Ponseti Method