Adhesion Issues After Tendon Injury: Treatment Options - Plastic Surgery

More Info

---

Adhesion issues after tendon injuries can be quite challenging and often lead to significant functional limitations. In your case, it seems that after sustaining a laceration to your left foot, particularly involving the tendon of your big toe, you have developed severe adhesion problems post-surgery. This is not uncommon, especially in cases where there has been significant trauma to the area, and it can be exacerbated by individual factors such as your predisposition to keloid formation.

To address your questions, let’s first discuss how scarring can influence adhesion formation. Scarring, particularly hypertrophic scars or keloids, can indeed contribute to adhesion formation. When the body heals, the formation of scar tissue is a natural part of the process. However, if the scar tissue is thick or adheres to surrounding structures, it can restrict movement and lead to pain. In your case, since you mentioned having a tendency for keloid formation, this could potentially increase the risk of adhesions in the area surrounding the tendon repair.

Regarding treatment options for tendon adhesions, there are several approaches you can consider:
1. Physical Therapy: Engaging in a structured rehabilitation program with a physical therapist can help improve mobility and reduce stiffness. Techniques such as manual therapy, stretching, and strengthening exercises can be beneficial. Sometimes, therapists may use modalities like ultrasound or electrical stimulation to promote healing and reduce pain.

2. Scar Management: Since you have a history of keloid formation, managing the scar effectively is crucial. This can include the use of silicone gel sheets, pressure garments, or topical treatments that may help flatten the scar and reduce adhesion formation.

3. Surgical Intervention: If conservative measures do not yield satisfactory results, surgical intervention may be necessary. A procedure known as adhesiolysis can be performed, where the surgeon carefully releases the adhesions that are restricting movement. This surgery is often done arthroscopically or through an open approach, depending on the extent of the adhesions and the specific anatomy involved.

4. Tendon Gliding Exercises: These exercises are designed to promote the movement of the tendon within its sheath and can help reduce the risk of adhesions forming. Your physical therapist can guide you on how to perform these exercises effectively.

5. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation associated with tendon adhesions. In some cases, corticosteroid injections may be considered to reduce inflammation and pain.

6. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture or massage therapy, which can help improve circulation and reduce tension in the affected area.

Before proceeding with any treatment, it is essential to have a thorough evaluation by an orthopedic specialist or a hand surgeon who can assess the extent of the adhesions and recommend the most appropriate course of action. They can also discuss the potential risks and benefits of surgical intervention, especially considering your history of keloid formation.

In summary, while adhesion issues can be frustrating and limiting, there are various treatment options available. Early intervention and a comprehensive rehabilitation approach are key to optimizing recovery and restoring function. If you are considering surgical options, ensure that you discuss all your concerns, including the potential impact of your scar tissue on the surgery and recovery process.