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CC BY-NC-ND 4.0 · Indian J Plast Surg 2010; 43(01): 014-020
DOI: 10.1055/s-0039-1699397
Original Article
Association of Plastic Surgeons of India

Two-stage reconstruction for flexor tendon injuries in zone II using a silicone rod and pedicled sublimis tendon graft

Mohammed Heshmat Abdul-Kader
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, New Damietta, Egypt
,
Mahmound A. M. Amin
1   Department of Surgery (Plastic Surgery Unit), Faculty of Medicine, Al-Azhar University, New Damietta, Egypt
› Author Affiliations
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Publication History

Publication Date:
08 January 2020 (online)

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ABSTRACT

We report the results of staged flexor tendon reconstruction in 12 patients (12 fingers) with neglected or failed primary repair of flexor tendon injuries in zone II. Injuries involved both flexor digitorum profundus (FDP) and flexor digitorum sublimis (FDS), with poor prognosis (Boyes grades II–IV). The procedure included placing a silicone rod and creating a loop between the FDP and FDS in the first stage and reflecting the latter as a pedicled graft through the pseudosheath created around the silicone rod in the second stage. At a mean follow-up of 18 months (range 12–30 months), results were assessed by clinical examination and questionnaire. The mean total active motion of these fingers was 188°. The mean power grip was 80.0% and pinch grip was 76% of the contralateral hand. The rate of excellent and good results was 75% according to the Buck-Gramcko scale. These results were better than the subjective scores given by the patients. Complications included postoperative hematoma in two, infection in one, silicone synovitis in one (after stage I) and three flexion contractures after stage II. This study confirmed the usefulness of two-stage flexor tendon reconstruction using the combined technique as a salvage procedure to restore flexor tendon function with a few complications.

KEY WORDS

Flexor tendon - pedicled sublimis tendon graft - staged reconstruction
 

  • REFERENCES

  • 1 Paneva-Holevich E. Two-stage plasty in flexor tendon injuries of fingers within the digital synovial sheath. Acta Chir Plast 1965;7:112-24.
  • 2 Hunter JM, Salisbury RE. Flexor tendon reconstruction in severely damaged hands: A two-stage procedure using a slincone-dacron reinforced gliding prosthesis prior to tendon grafting. J Bone Joint Surg Am 1971;53:829-58.
  • 3 Kessler FB. Use of a pedicled tendon transfer with a silicone rod in complicated secondary flexor tendon repairs. Plast Reconstr Srug 1972;49:439-43.
  • 4 Chong JK, Cramer LM, Culf NK. Combined two-stage tenoplasty with silicone rods for multiple flexor tendon injuries in “no-man's-land”. J Trauma 1972;12:104-21.
  • 5 Alms M. Pedicled tendon graft for flexor tendon injuries of the fingers. J Bone Joint Surg Br 1973;55:881-2.
  • 6 Winspur I, Phelps DB, Boswick JA Jr. Staged reconstruction of flexor tendons with a silicone rod and a “pedicled” sublimis transfer. Plast Reconstr Surg 1978;61:756-61.
  • 7 Brug E, Stedtfeld HW. Experience with a two-staged pedicled flexor tendon graft. Hand 1979;11:198-205.
  • 8 Chuinard RG, Dabezies EJ, Mathews RE. Two-stage superficialis tendon reconstruction in severely damaged fingers. J Hand Surg Am 1980;5:135-43.
  • 9 Naam NH. Staged flexor tendon reconstruction using pedicled tendon graft from flexor digitorum superficialis. J Hand Surg Am 1997;22:323-7.
  • 10 Boyes JH, Stark HH. Flexor tendon grafts in the fingers and thumb: A study of factors influencing results in 1000 cases. J Bone Joint Surg Am 1971;53:1332-42.
  • 11 Wehbe MA, Mawr B, Hunter JM, Schneider LH, Goodwyn BL. Two stage flexor tendon reconstruction: Ten-year experience. J Bone Joint Surg Am 1986;68:752-63.
  • 12 Bruner JM. The zig-zag volar digital incision for flexor tendon surgery. Plast Reconstr Surg 1967;40:571-4.
  • 13 Lister GD, Kleinert HE, Kutz JE, Atasoy E. Primary flexor tendon repair followed by immediate controlled mobilization. J Hand Surg Am 1977;2:441-51.
  • 14 Frakking TG, Depuydt KP, Kon M, Werker PM. Retrospective outcome analysis of staged flexor tendon reconstruction. J Hand Surg Br 2000;25:168-74.
  • 15 LaSalle WB, Strickland JW. An evaluation of the two-stage flexor tendon reconstruction technique. J Hand Surg Am 1983;8:263-7.
  • 16 Amadio PC, Wood MB, Cooney WP 3rd, Bogard SD. Staged flexor tendon reconstruction in the fingers and hand. J Hand Surg Am 1988;13:559-62.
  • 17 Strickland JW. Development of flexor tendon surgery: Twenty-five years of progress. J Hand Surg Am 2000;25:214-35.
  • 18 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.
  • 19 Gelberman RH, Vande Berg JS, Lundborg GN, Akeson WH. Flexor tendon healing and restoration of the gliding surface: An ultrastructural study in dogs. J Bone Joint Surg Am 1983;65:70-80.
  • 20 Carlson GD, Botte MJ, Josephs MS, Newton PO, Davis JL, Woo SL. Morphological and biomechanical comparison of tendons used as free grafts. J Hand Surg Am 1993;18:76-82.
  • 21 Wehbe MA. Tendon graft anatomy and harvesting. Orthop Rev 1994;23:253-6.
  • 22 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.
  • 23 Soucacos PN, Beris AE, Malizos KN, Zenakis T, Touliatos A, Soucacos PK. Two-stage treatment of flexor tendon ruptures: Silicone rod complications analyzed in 109 digits. Acta Orthop Scand 1997;68:48-51.
  • 24 Valenti P, Gilbert A. Two-stage flexor tendon grafting in children. Hand Clin 2000;16:573-8.
  • 25 Paneva-Holevich E. Two stage tenoplasty results. Tendon surgery in the hand. In: Hunter JM, Schneider LH, Mackin EJ, editors. St. Louis: CV Mosby; 1987. p. 272-81.