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Research Article| Volume 22, ISSUE 2, P323-327, March 1997

Staged flexor tendon reconstruction using pedicled tendon graft from the flexor digitorum superficialis

  • Author Footnotes
    1 From the Department of Plastic and Reconstructive Surgery, Southern Illinois University Medical School, Springfield, IL, and the Southern Illinois Hand Center, Effingham, IL.
    Nash H. Naam
    Correspondence
    Reprint requests: Nash H. Naam, MD, Southern Illinois Hand Center, 901 Medical Park Drive, Suite 100, Effingham, IL 62401.
    Footnotes
    1 From the Department of Plastic and Reconstructive Surgery, Southern Illinois University Medical School, Springfield, IL, and the Southern Illinois Hand Center, Effingham, IL.
    Affiliations
    Effingham, IL, USA
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  • Author Footnotes
    1 From the Department of Plastic and Reconstructive Surgery, Southern Illinois University Medical School, Springfield, IL, and the Southern Illinois Hand Center, Effingham, IL.
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      The use of pedicled flexor digitorum superficialis tendon as a tendon graft in the second stage of flexor tendon reconstruction has the advantage of employing local intrasynovial tendon graft and allowing early active range of motion. This method of staged flexor tendon reconstruction was used in 47 patients between 1083 and 1993. Thirty-three patients were evaluated 1 year or longer after the second stage of surgery. The follow-up period averaged 3.7 years. Sixty-four percent of the injuries were in zone II, and 30% were Boyes grade V in severity. Good to excellent results were achieved in 64% of patients. Three patients needed graft tenolysis. Postoperative persistent flexion contractures ranging from 8° to 55° of the proximal interphalangeal or distal interphalangeal joints or both were present in 88% of patients. Several factors that influenced the final outcome were identified: age over 25 years, zone II injuries of Boyes grade V, and the lack of a regular postoperative rehabilitation program were associated with relatively less successful final results.
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      References

        • Paneva-Holevich E
        Two-stage plasty in flexor tendon injuries of fingers within the digital synovial sheath.
        Acta Chir Plast. 1965; 7: 112-124
        • Paneva-Holevich E
        Two-stage tenoplasty in injury of the flexor tendons of the hand.
        J Bone Joint Surg. 1969; 51A: 21-32
        • 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. 1971; 53A: 829-858
        • Kessler FB
        Use of a pedicled tendon transfer with a silicone rod in complicated secondary flexor tendon repairs.
        J Plast Reconstr Surg. 1972; 49: 439-443
        • 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: 104-121
        • Alms A
        Pedicle tendon graft for flexor tendon injuries of the fingers.
        J Bone Joint Surg. 1973; 55B: 881-882
        • Winspur I
        • Dennis PB
        • Boswick JA
        Staged reconstruction of flexor tendons with a silicone rod and a “pedicled” sublimis transfer.
        Plast Reconstr Surg. 1978; 61: 756-761
        • Brug E
        • Stedtfeld HW
        Experience with a two-stage pedicled flexor tendon graft.
        Hand. 1979; 11: 198-205
        • Chuinard RG
        • Dabezies EJ
        • Mathews RE
        Two stage superficialis reconstruction in severely damaged fingers.
        J Hand Surg. 1980; 5: 135-143
        • Paneva-Holevich E
        Two-stage tenoplasty: result.
        in: Hunter JM Schneider LH Mackin EJ Tendon surgery in the hand. CV Mosby, St. Louis1987: 272-281
        • Amadio PC
        • Wood MB
        • Cooney III, WP
        • Board SD
        Staged flexor tendon reconstruction in the fingers and hand.
        J Hand Surg. 1988; 13A: 559-562
        • Wehbe MA
        • Hunter JM
        • Schneider LH
        • Goodwyn BL
        Two-stage flexor-tendon reconstruction: ten-year experience.
        J Bone Joint Surg. 1986; 68A: 752-763
        • Boyes JH
        Flexor tendon grafts in the fingers and thumb: an evaluation of end results.
        J Bone Joint Surg. 1950; 32A: 489-499
        • 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. 1971; 53A: 1332-1342
        • Bruner JM
        The zig-zag volar-digital incision for flexor tendon surgery.
        J Plast Reconstr Surg. 1967; 40: 571-574
        • Lister GD
        • Kleinert HE
        • Kutz JE
        • Atasoy E
        Primary flexor tendon repair followed by immediate controlled mobilization.
        J Hand Surg. 1977; 2: 441-451
        • Duran RJ
        • Houser RG
        • Stover MG
        Management of flexor tendon lacerations in zone 2 using controlled passive motion postoperatively.
        in: Hunter JM Schneider LH Mackin E Bell J Rehabilitation of the hand. CV Mosby, St. Louis1978: 219-224
        • Schneider LH
        Staged flexor tendon reconstruction using the method of Hunter.
        Clin Orthop. 1982; 171: 164-171
        • LaSalle WB
        • Strickland JW
        An evaluation of the two-stage flexor tendon reconstruction technique.
        J Hand Surg. 1983; 8: 263-267
        • Strickland JW
        • Glogovac SV
        Digital function following flexor tendon repair in zone II: a comparison of immobilization and controlled passive motion techniques.
        J Hand Surg. 1980; 5: 537-543
        • Lundborg G
        Experimental flexor tendon healing without adhesion formation: a new concept of tendon nutrition and intrinsic healing mechanisms. A preliminary report.
        Hand. 1976; 8: 235-238
        • Lundborg G
        • Rank F
        Experimental intrinsic healing of flexor tendons based upon synovial fluid nutrition.
        J Hand Surg. 1978; 3: 21-31
        • Gelberman RH
        • Seiler III, JG
        • Rosenberg AE
        • Heyman P
        • Amiel D
        Intercalary flexor tendon grafts: a morphological study of intrasynovial and extrasynovial donor tendons.
        Scandinavian J Plast Reconstr Surg Hand Surg. 1992; 26: 257-264
        • 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. 1983; 65A: 70-80
        • Seiler III, JG
        • Gelberman RH
        • Williams CS
        • et al.
        Autogenous flexor tendon grafts: a biomechanical and morphological study in dogs.
        J Bone Joint Surg. 1993; 75A: 1004-1014
        • Schneider LH
        Staged tendon reconstruction.
        Hand Clin. 1985; 1: 109-120