Minimally Invasive Tenolysis With Fat Grafting: A Novel Approach
Raul A. Cortes, MD1, Daniel Calva-Cerqueira, MD2, roger K. khouri, MD2.
1Miami Hand Center, Key Biscayne, FL, USA, 2Miami Hand Center, Miami, FL, USA.
Stiffness with loss of motion represents the Achilles heel of hand surgery. Pathology such as tendon lacerations, fractures, and crush injuries may be accurately managed operatively but return to preinjury status may not occur despite dedicated postoperative hand therapy. Tenolysis is one modality that addresses stiffness by mechanically disrupting scar tissue formed around tendons. We describe our experience with a novel technique using minimally invasive approaches and fat grafting. Fat grafting provides a gliding tendon surface, reduces scar formation and optimizes wound conditions.
All patients were treated under local anesthesia using a percutaneously introduced spatulated cannula as a freer along the fibro-osseous canal to mechanically release the adhesions while delivering a tumescent lipoaspirate. Afterwards, with L-Shaped 18G needles we percutaneously separate the skeletal-to-tendons adhesions and mesh expand any skin contracture. The incisions are minimal, postoperative therapy is initiated at day three and patients followed for a minimum of 6 months.
102 digits were tenolysed on 68patients over 4years. Mean operative duration was 48minutes, average infiltration measured 10ml per digit. Measured total active motion (TAM) was less than 75% before surgery and all achieved 75% TAM or greater, postoperative. Pain scores improved by >33% and 66/68 patients stated they would perform the procedure again. Postoperative complications included 2 tendon ruptures, 12 superficial wounds/infections, and donor site pain in 2 patients.
Our experience demonstrates the efficacy of a novel technique using both a minimally invasive approach and fat grafting to improve outcomes in patients with stiff hands and fingers.
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