Tendon deficiency limits repair and reconstructive options after tendon and nerve
injuries of the upper extremity. Current treatment options include intercalary tendon
autograft, tendon transfers, and two-stage tenodesis, with sacrifice of the flexor
digitorum superficialis. These reconstructive techniques are associated with donor
site morbidity and limited in the setting of multiple tendon deficiencies. The tendon
with z-lengthening (TWZL) technique is presented here as an alternative treatment
method for tendon injuries and tendon transfer reconstruction after nerve injuries.
The TWZL technique involves splitting a tendon longitudinally, reflecting the freed
tendon limb distally, and suture augmentation at the bridge site located at the distal
end of the native tendon. The TWZL technique has applications throughout the upper
extremity—flexor and extensor tendons injuries, biceps and triceps tendon injuries,
and tendon transfers for restoration of hand function after nerve injuries. An illustrative
case example is also provided. The experienced hand surgeon should consider the TWZL
technique as a potential treatment option when faced with difficult clinical conditions
of the hand and upper extremities.
Key Words
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Article info
Publication history
Published online: March 04, 2023
Accepted:
December 23,
2022
Received:
November 9,
2021
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly to this article.
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© 2023 by the American Society for Surgery of the Hand. All rights reserved.
