Purpose
This study aimed to assess the outcome of a modified two-stage flexor tendon reconstruction
using silicone tubes as antiadhesion devices while performing simultaneous tendon
grafting.
Methods
From April 2008 to October 2019, 16 patients (21 fingers) with zone II flexor tendon
injuries, who sustained failed tendon repair or neglected tendon laceration, were
treated by a modified two-stage flexor tendon reconstruction. The first stage of treatment
comprised flexor tendon reconstruction with interposition of silicone tubes to minimize
fibrosis and adhesion around the tendon graft; the second stage of treatment comprised
silicone tube removal under local anesthesia.
Results
The patient median age was 38 (range, 22–65) years. After a median follow-up period
of 14 (range, 12–84) months, the median total active motion (TAM) of fingers was 220°
(range, 150–250°). Excellent and good TAM ratings were identified in 71.4%, 76.2%,
and 76.2% according to the Strickland, modified Strickland, and American Society for
Surgery of the Hand (ASSH) evaluation systems, respectively. At follow-up, complications
included superficial infections in two fingers of one patient whose silicone tube
was removed 4 weeks postoperatively. The most common complication was a flexion deformity
of the proximal interphalangeal joint (four fingers) and/or distal interphalangeal
joint (nine fingers). The rate of failed reconstruction was higher in patients with
preoperative stiffness and infection.
Conclusions
Silicone tubes are suitable antiadhesion devices, and the modified two-stage flexor
tendon reconstruction technique is an alternative procedure with a shorter rehabilitation
period for complicated flexor tendon injury, compared with current popular reconstructions.
Preoperative stiffness and postoperative infection may compromise the final clinical
outcome.
Type of study/level of evidence
Therapeutic IV.
Key Words
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Article info
Publication history
Published online: February 28, 2023
Accepted:
January 4,
2023
Received:
August 13,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.
