Published: 2016-12-19

Two stage flexor tendon reconstruction in hand: our experience

Tawheed Ahmad, Mir Mohsin, Mohammad Inam Zaroo, Sheikh Adil Bashir, Adil Hafeez Wani, Haroon Rashid Zargar, Altaf Rasool, Peerzada Umar Farooq Baba, Akram Hussain Bijli, Summaira Jan, Saima Rashid, Shabir Ahmad Langoo, Mushtaq Ahmed Bhat


Background: Flexor tendon injuries in the digital flexor sheath area (zone II) are the most difficult to treat and remain a focus of both clinical attention and basic investigations. This prospective study was designed to evaluate the results of staged zone II flexor tendon repair.

Methods: Seventy digits in thirty five patients were treated by Two Stage flexor tendon reconstruction and followed for an average of one and a half year. The procedure included placing a silicone catheter (cut to desire size) as an active implant and reconstruction of A2, A4 or both pulleys if damaged in first stage. During the second stage (performed three to eight months later), tendon graft replaced the silicone catheter in the pseudo sheath formed around the catheter. The proximal end of the transplanted tendon was fixed with flexor digitorum profundus tendon of respective finger using the Pulvertaft method, and the distal end of the graft was fixedwith the distal stump of respective flexor digitorum profundus tendon. Early controlled motion protocol was instituted in all cases.

Results: As per Buck Gramcko scale total active motion obtained was Excellent in 70%, Good in 20%, Fair in 7.1%, and Poor in 2.9% of patients.

Conclusions: Flexor tendon reconstruction using two stage tendon reconstructions is an effective way to restore digital tendon function in delayed zone II flexor tendon injuries.


Flexor tendon injury, Tendon graft, Staged tendon reconstruction

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