Orthopedics and Traumatology

, Volume 9, Issue 4, pp 231–244 | Cite as

The Two-Stage Free Flexor Tendon Grafting of the Hand

Article
First Online:
  • 48 Downloads

Abstract

Objective

Reconstruction of prehension after remote flexor tendon injury or flexor tendon destruction after disease or infection.

Indications

Absence of passive motion of proximal and distal interphalangeal joints.

Uncooperative patient. Children under 5 years of age.

Acute local or serious systemic infection.

Injury of both digital nerves; circulatory disturbances.

Surgical Technique

Stage 1: plexus block. Tourniquet. Bruner skin incision. Exploration of tendon and tendon sheaths while preserving or reconstructing pulleys. Revision of scar. Insertion of a silicone spacer. Plaster cast for 2 weeks. Passive mobilization of fingers during 8 weeks.

Stage 2: at the earliest 10 weeks after insertion of spacer when the passive range of motion is complete: Z-incisions over distal interphalangeal joint and palm, removal of spacer and insertion of palmaris longus tendon, suture at the proximal end and anchorage to the base of the distal phalanx.

Results

Using the score of Buck-Gramcko et al., we found 56.2% excellent and good results in 311 patients who underwent either a two-staged tendon grafting (n = 210) or a two-staged pedicled tendon grafting (n = 101). Follow-up after an average of 43 months (8–111 months) after the second stage.

Due to complications, revision surgery became necessary in 19 patients (23 fingers = 13.8%): four ruptures of the ten-don graft, three dehiscences of tendon suture, four avulsions of spacer, two perforations of spacer, four adhesions, two pulley insufficiencies, two scar contractures, and two painful neuromas.

Key Words

Flexor tendon grafting Two-stage procedure Silicone spacer 
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Adamson JE, Wilson JN. The history of tendon grafting. J Bone Joint Surg Am 1961;43:709–16.PubMedGoogle Scholar
  2. 2.
    Bassett AL, Carroll RE. Formation of tendon sheath by silicone rod implants. J Bone Joint Surg Am 1963;45:884–5.Google Scholar
  3. 3.
    Berger A, Deisenhammer W. Erfahrungen mit der zweizeitigen Beugesehnentransplantation. Handchirurgie 1978;10:223–5.PubMedGoogle Scholar
  4. 4.
    Biesalski K. Ueber Sehnenscheidenauswechselung. Deutsch Med Wochenschr 1910;36:1615–8.CrossRefGoogle Scholar
  5. 5.
    Biesalski K, Mayer L. Die physiologische Sehnenverpflanzung. Berlin: Springer, 1916.Google Scholar
  6. 6.
    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.PubMedGoogle Scholar
  7. 7.
    Brug E, Stedtfeld HW. Experience with a two-staged pedicled flexor tendon graft. Hand 1979;11:198–205.PubMedCrossRefGoogle Scholar
  8. 8.
    Brug E, Wetterkamp D, Neuber M, Probst A. Die sekundäre Rekonstruktion der Beugesehnenfunktion an den Fingern. Unfallchirurg 1998;101:415–25.PubMedCrossRefGoogle Scholar
  9. 9.
    Bruner JM. The zig-zag volar-digital incision for flexor-tendon surgery. Plast Reconstr Surg 1967;40:571–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Buck-Gramcko D, Dietrich F, Gögge S. Bewertungskriterien bei Nachuntersuchungen von Beugesehnenwiederherstellungen. Handchirurgie 1976;8:65–9.PubMedGoogle Scholar
  11. 11.
    Bunnell S. Repair of tendons in the fingers and description of two new instruments. Surg Gynecol Obstet 1918;26:103–10.Google Scholar
  12. 12.
    Duran RJ, Houser RG. Controlled passive motion following flexor tendon repair in zones II and III. In: American Association of Or-thopedic Surgeons, ed. AAOS symposium on tendon surgery of the hand. St. Louis: Mosby, 1975:105–14.Google Scholar
  13. 13.
    Frohse F, Fränkel M. Die Muskeln des menschlichen Armes. In: Bardeleben K von, Hrsg. Handbuch der Anatomie des Menschen, 2. Abt, 2. Teil. Jena: Fischer, 1908.Google Scholar
  14. 14.
    Geldmacher J. Die zweizeitige freie Beugesehnentransplanta-tion. Handchirurgie 1969;3:109–20.Google Scholar
  15. 15.
    Gluck T. Ueber Muskel- und Sehnenplastik. Arch Klin Chir 1881; 26:61–6.Google Scholar
  16. 16.
    Hacker V von. über den autoplastischen Ersatz der Streck- und der Beugesehne der Finger durch entbehrliche Sehnen des Handrückens. Bruns Beitr Klin Chir 1910;66:259–79.Google Scholar
  17. 17.
    Haussmann P. Verschleppte Perforation eines Kunststoffplatzhal-ters nach Beugesehnenverletzung. Handchirurgie 1978;10:237–8.PubMedGoogle Scholar
  18. 18.
    Heuck G. Ein Beitrag zur Sehnenplastik. Zentralbl Chir 1882;9: 289–92.Google Scholar
  19. 19.
    Holle J, Freilinger G, Mandl H. Die zweizeitige Beugesehnentransplantation in der Replantationschirurgie. Handchirurgie 1978;10: 233–6.PubMedGoogle Scholar
  20. 20.
    Honner R, Meares A. A review of 100 flexor tendon reconstructions with prosthesis. Hand 1977;3:226–31.CrossRefGoogle Scholar
  21. 21.
    Hunter JM. Staged flexor tendon reconstruction. J Hand Surg 1983;8:789–93.CrossRefGoogle Scholar
  22. 22.
    Hunter JM, Salisbury RE. Flexor-tendon reconstruction in severely damaged hands: a two-stage procedure using a silicone-Dacron reinforced gliding prothesis prior to tendon grafting. J Bone Joint Surg Am 1971;53:829–58.PubMedGoogle Scholar
  23. 23.
    Khan K, Riaz M, Murison MS, Brennen MD. Early active mobilization after second flexor tendon grafts. J Hand Surg [Br] 1997;22: 372–4.CrossRefGoogle Scholar
  24. 24.
    Kirschner M. Ueber freie Sehnen- und Fascientransplantation. Beitr Klin Chir 1909;65:472–503.Google Scholar
  25. 25.
    LaSalle WB, Strickland JW. An evaluation of the two stage flexor tendon reconstruction technique. J Hand Surg 1983;8:263–7.CrossRefGoogle Scholar
  26. 26.
    Lengemann F. Eine neue Drahtnaht für Sehnen. Zentralbl Chir 1951;14:964–7.Google Scholar
  27. 27.
    Lexer E. Die Verwerthung der freien Sehnentransplantation. Lan-genbecks Arch Klin Chir 1912;98:818–25.Google Scholar
  28. 28.
    Madee W, Reill P. Langzeitergebnisse zweizeitiger Beugesehnentransplantationen. Handchir Mikrochir Plast Chir 1983;15: 245–9.PubMedGoogle Scholar
  29. 29.
    Mayer L. The physiological method of tendon transplantation. Surg Gynecol Obstet 1916;22:182–97, 298–306, 472–81.Google Scholar
  30. 30.
    Mayou BJ, Harrison SH. The length of flexor tendon grafts. Hand 1978;10:48–51.PubMedCrossRefGoogle Scholar
  31. 31.
    McClinton MA, Curtis RM, Wilgis EF. One hundred tendon grafts for isolated flexor digitorum profundus injuries. J Hand Surg 1982;7:224–9.CrossRefGoogle Scholar
  32. 32.
    Naam NH. Staged flexor tendon reconstruction using pedicled tendon graft from flexor digitorum superficialis. J Hand Surg [Am] 1997;22:65–70.CrossRefGoogle Scholar
  33. 33.
    Nigst H. Chirurgie der Beugesehnen. Handchirurgie 1976;8:225–36.Google Scholar
  34. 34.
    Paneva-Holevich E. Two-stage tenoplasty in injury of the flexor tendons of the hand. J Bone Joint Surg Am 1969;51:21–32.PubMedGoogle Scholar
  35. 35.
    Parkes A. The “lumbrical plus” finger. Hand 1970;2:164–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Pulvertaft RG. Tendon grafts for the flexor tendon injuries in the fingers and thumbs. J Bone Joint Surg Br 1956;38:175.PubMedGoogle Scholar
  37. 37.
    Pulvertaft RG. The treatment of profundus division by free tendon graft. J Bone Joint Surg Am 1960;42:1363–71.Google Scholar
  38. 38.
    Pulvertaft RG. Problems of flexor tendon surgery of the hand. J Bone Joint Surg Am 1965;47:123–32, 145.PubMedGoogle Scholar
  39. 39.
    Rehn E. Die homoplastische Sehnentransplantation im Tierexperiment. Beitr Klin Chir 1910;68:417–47.Google Scholar
  40. 40.
    Reill P. Die zweizeitige Beugesehnentransplantation. Handchirurgie 1978;10:215–21.PubMedGoogle Scholar
  41. 41.
    Schneider LH. Staged flexor tendon reconstruction using the method of Hunter. Clin Orthop 1982;171:164–71.PubMedGoogle Scholar
  42. 42.
    Stark HH, Zemel NP, Boyes JH, Ashworth CR. Flexor tendon graft through intact superficialis tendon. J Hand Surg 1977;2:456–64.CrossRefGoogle Scholar
  43. 43.
    Urbaniak JR, Bright DS, Gill LH, Goldner JL. Vascularization and the gliding mechanism of free flexor-tendon grafts inserted by the silicone-rod method. J Bone Joint Surg Am 1974;56:473–82.PubMedGoogle Scholar
  44. 44.
    Vastamaki M. Median nerve as free tendon graft. J Hand Surg [Br] 1987;12:187–8.CrossRefGoogle Scholar
  45. 45.
    Veihelmann D, Schweizer P. Materialbedingte Komplikationen nach Gleitlagerplastik für zweizeitige Beugesehnentransplantation. Handchirurgie 1978;10:239–40.PubMedGoogle Scholar
  46. 46.
    Verdan CE, Michon J. Le traitement des plaies des tendons fléchisseurs des doigts. Rev Chir Orthop 1961;47:285–425.PubMedGoogle Scholar
  47. 47.
    Wehbè MA. Tendon grafts donor sites. J Hand Surg [Am] 1992;17: 1130–2.CrossRefGoogle Scholar
  48. 48.
    Wehbè MA, Mawr AB, Hunter JM, Schneider LH, Goodwyn LB. Two stage flexor tendon reconstruction. J Bone Joint Surg Am 1986;68:752–63.PubMedGoogle Scholar
  49. 49.
    Wilhelm K, Hauer G, Feldmeier C. Die zweizeitige Beugesehnentransplantation — Nachuntersuchungsergebnisse. Handchirurgie 1978;10:227–31.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2001

Authors and Affiliations

  1. 1.Department of Trauma and Hand SurgeryUniversity HospitalMünsterGermany

Personalised recommendations