Original CommunicationsStaged flexor tendon reconstruction fingertip to palm*,**
Section snippets
Material and methods
Between 1971 and 1998, 49 patients had 2-stage fingertip to palm flexor tendon reconstruction. Fifteen patients had incomplete documentation for inclusion in this study or were lost to follow-up evaluation, leaving 34 patients with 35 digits as the basis of the study. We re-examined 14 patients and reviewed charts on the remaining 20 patients who had adequate documentation of joint motion. Thumb injuries were not included.
The cohort included 24 men and 10 women with an average age of 26.4 years
Surgical technique
Our surgical technique followed the well-established procedures of Hunter2 and Hunter and Salisbury3 and Schneider5, 6 with the following modifications. Some patients had either injury or prior surgical scarring in the palm but none so severe to preclude this technique.
At stage I the palm was explored and the superficialis tendon lysed, pulled distally, transected, and allowed to retract into the forearm. The profundus tendon was tenolysed, and 2 cm of tendon distal to the lumbrical muscle was
Results
The mean TAM of all digits was 206° (range, 140° to 260°). Thirteen digits (37%) were rated group I (excellent), 11 (32%) group II (good), 7 (20%) group III (fair), and 4 (11%) group IV (poor). Results by digit involved were also tabulated (Table 2).Empty Cell Group Digit I II III IV Index 5 4 2 2 Middle 1 0 1 0 Ring 3 4 1 0 Little 4 3 3 2
Profundus avulsion injuries had the better clinical results with a mean TAM of 234° compared with the tendon lacerations, which had a mean TAM of 201° (Table 3).
Discussion
When the palm is free of substantial injury and scar and the proximal end of the profundus tendon remains in the palm, placement of the silicone tendon implant from fingertip to palm seems intuitive. Rowland7 described this modified technique in 1975 and reported 6 of 12 patients attaining fingertip pulp flexion within 0.6 cm or better to the distal palmar crease. Chamay et al9 reported twenty-four 2-staged reconstructions (6 palm, 18 distal forearm) with results more favorable when tenorrhaphy
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Cited by (24)
Flexor Tendon Reconstruction
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2022, Hand Surgery and RehabilitationCitation Excerpt :It also serves for confirmation of tendon repair solidity and repair tension adjustment during intraoperative mobilization of the patient [1]. Delayed management of a jersey finger with flexor digitorum profundus (FDP) avulsion is a therapeutic challenge, with no consensus [2–6]. Recently, ultrasound-assisted tendon reinsertion under WALANT has been reported [7].
Two-Stage Flexor Tendon Reconstruction with Silicone Rod
2018, Operative Techniques: Hand and Wrist SurgeryGraft reconstruction of flexor tendons
2014, Chirurgie de la MainTendon 'turnover lengthening' technique
2013, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :Fractional step lengthening tenotomy involves surgical release at the musculotendonous junction, but actual length gain may be limited. Tendon grafting using the palmaris longus, plantaris or index finger extensor digitorum communis tendons as donors for interpositional grafting inflicts additional donor site morbidity and often results in poor outcomes.8,10–13 Two stage tendon reconstruction involving silastic rod insertion, and tenoplasty using both flexor digitorum profundus and superficialis tendons, are technically challenging and require intensive rehabilitation before benefit is appreciated.3,14,15
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No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
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