Original Communications
Staged flexor tendon reconstruction fingertip to palm*,**

https://doi.org/10.1053/jhsu.2002.34319Get rights and content

Abstract

Thirty-five fingertip to palm staged flexor tendon reconstructions were performed between 1971 and 1998. Tendon injuries involved 5 avulsions and 30 lacerations, 9 of which had failed primary tenorrhaphies. Follow-up evaluation averaged 30 months. Thirteen patients had total active motion (TAM) of ≥220° (excellent), 11 patients had TAM of 200° to 219° (good), 7 patients had TAM of 180° to 199° (fair), and 4 patients had TAM of <180° (poor). Less favorable results occurred in those with a >1-year interval between injury and stage I, in those with a >6-month interval between stage I and stage II, and in those with a higher injury severity classification. Fingertip to palm staged flexor tendon reconstruction produced 69% good to excellent results. This technique allows the use of the injured digit profundus as the motor, preserves lumbrical function, and requires less tendon graft length (palmaris longus usually suffices). (J Hand Surg 2002;27A:581–585. Copyright © 2002 by the American Society for Surgery of the Hand.)

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).

. Results by digit involved

Empty CellGroup
DigitIIIIIIIV
Index5422
Middle1010
Ring3410
Little4332

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).

. Results

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

References (16)

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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.

**

Reprint requests: Michael P. Coyle, Jr, 215 Easton Ave, New Brunswick, NJ 08901.

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