The Effects of Edema & Self Adhesive Wrap on the Work of Flexion in a Cadaveric Hand Samuel D Buonocore MD

Y A L E P L A S T I C S U R G E R Y Purpose: To determine if the application of self adhesive wraps increase the work of flexion when hand therapy is initiated in edematous fingers.

Y A L E P L A S T I C S U R G E R Y Introduction: Forces generated in a repaired tendon are likely to be greater given the presence of edema, joint stiffness, muscle contracture, and the presence of the suture material within the tendon. Early active protocols are often started within 24 hours of surgery and because edema can be significant 48 hours postoperatively, it is a common clinical scenario for hand therapy to be initiated in edematous digits. To address this problem, self-adherent wraps are used in the postoperative period to try to eliminate edema. This study aims to determine if the presence of self-adherent wraps increase the work of flexion during early motion protocols.

Y A L E P L A S T I C S U R G E R Y Materials and Methods: A single fresh-frozen cadaveric hand with the distal 1/3 of the forearm intact was obtained. Flexor digitorum profundus tendons & flexor pollicis longus tendons were identified and dissected in the forearm, Excursion of the flexor tendons for each of the digits was measured, the hand was then placed in a tensile testing machine, force excursion curves were generated for various clinical scenarios, including varying amounts of edema and the presence of two types of self adherent wraps. Work of flexion (WOF) was calculated from the force excursion curves.

Y A L E P L A S T I C S U R G E R Y Results: Statistically significant increases in the WOF were noted for each of the clinical scenarios simulated, compared to the fingers baseline values for the WOF. The increase in the WOF noted after the application of self adherent wraps was greater than the increase noted for moderate edema. The effects on WOF were additive when both edema and self adherent wraps were present. The results were consistent among all 5 fingers tested.

Y A L E P L A S T I C S U R G E R Y Conclusion: Both the presence of edema and self adherent wraps increases the work of flexion in fingers in this cadaveric model. Therapists and surgeons should be aware of the potential for increased stress placed on tendons when early motion protocols are initiated in these situations. We recommend the removal of self adherent wraps before the therapy session begins, this is especially true if edema is also present.