Two stage flexor tendon reconstruction in hand: our experience

Authors

  • Tawheed Ahmad Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
  • Mir Mohsin Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
  • Mohammad Inam Zaroo Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
  • Sheikh Adil Bashir Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
  • Adil Hafeez Wani Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
  • Haroon Rashid Zargar Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
  • Altaf Rasool Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
  • Peerzada Umar Farooq Baba Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
  • Akram Hussain Bijli Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India
  • Summaira Jan Department of Anaesthesiology, SKIMS, Srinagar, Jammu and Kashmir, India
  • Saima Rashid Department of Anatomy, GMC, Jammu, Jammu and Kashmir, India
  • Shabir Ahmad Langoo Department of Anaesthesiology, SKIMS, Srinagar, Jammu and Kashmir, India
  • Mushtaq Ahmed Bhat Department of Plastic and Reconstructive Surgery, SKIMS, Srinagar, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20163485

Keywords:

Flexor tendon injury, Tendon graft, Staged tendon reconstruction

Abstract

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.

References

David G, Robert S. Flexor tendon injuries and reconstruction. In: Stephen J Mathes and Vincent R Hentz. Text book of plastic surgery, second edition. Saunder Elsevier; 2006:352.

Hunter JM, Salisbury RE. Flexor-tendon reconstruction in severely damaged hands. A two-stage procedure using a Silicone-dacron reinforced gliding prosthesis prior to tendon grafting. J Bone Joint Surg Am. 1971;53:829-58.

Courvoisier A, Pradel P, Dautel G. Surgical outcome of one-stage and two-stage flexor tendon grafting in children. J Pediatr Orthop. 2009;29(7):792-6.

Unglaub F, Bultmann C, Reiter A, Hahn P. Two-

staged reconstruction of the flexor pollicis longus tendon. J Hand Surg Br. 2006;31:432-5.

Smith P, Jones M, Grobbelaar A. Two-stage grafting of flexor tendons: results after mobilisation by controlled early active movement. Scand J PlastReconstrSurg Hand Surg. 2004;38:220-7.

Beris AE, Darlis NA, Korompilias AV, Vekris MD, Mitsionis GI, Soucacos PN. Two-stage flexor tendon reconstruction in zone II using a silicone rod and a pedicled intrasynovial graft. J Hand Surg Am. 2003;28:652-60.

Soucacos PN. Secondary flexor tendon reconstruction. In: Duparc S, ed. Textbook on Techniques in Orthopaedic Surgery and Traumatology. Paris, France: Elsevier SAS; 2000:55-340.

Strickland JW. Development of flexor tendon surgery: twenty-five years of progress. J Hand Surg Am. 2000;25:214-35.

Viegas SF. A new modification of two-stage flexor tendon reconstruction. Tech Hand Up Extrem Surg. 2006;10:177-80.

Darlis NA, Beris AE, Koromphilias AV, Vekris MD, Mitsionis GI, Soucacos PN. Two-stage flexor tendon reconstruction in zone 2 of the hand in children. J Pediatr Orthop. 2005;25:382-6.

Valenti P, Gilbert A. Two-stage flexor tendon grafting in children. Hand Clin. 2000;16:573-8.

Bruner JM. The zig-zag volar-digital incision for flexor-tendon surgery. Plast Reconstr Surg. 1967;40(6):571-4.

American Society for Surgery of the Hand (ASSH). Clinical Assessment Committee Report. Rosemont, IL: Churchill Livingstone; 1976.

Bassett CAL, Carroll RE. Formation of tendon sheaths by silicone rod implants. Proceedings of American Society for Surgery of the Hand. J Bone Joint Surg Am. 1963;(45):884.

Khanna A, Friel M, Gougoulias N, Longo UG, Maffulli N. Prevention of adhesions in surgery of the flexor tendons of the hand: what is the evidence.Br Med Bull. 2009;(90):85-109.

Khanna A, Gougoulias N, Maffulli N. Modalities in prevention of flexor tendon adhesion in the hand: what have we achieved so far? Acta Orthop Belg. 2009;75(4):433-44.

Rispler D, Greenwald D, Shumway S, Allan C, Mass D. Efficiency of the flexor tendon pulley system in human cadaver hands. J Hand Surg Am. 1996;21(3):444-50.

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Published

2016-12-19

How to Cite

Ahmad, T., Mohsin, M., Zaroo, M. I., Bashir, S. A., Wani, A. H., Zargar, H. R., Rasool, A., Baba, P. U. F., Bijli, A. H., Jan, S., Rashid, S., Langoo, S. A., & Bhat, M. A. (2016). Two stage flexor tendon reconstruction in hand: our experience. International Journal of Research in Medical Sciences, 4(11), 4697–4700. https://doi.org/10.18203/2320-6012.ijrms20163485

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Section

Original Research Articles