|The results of repair or
reconstruction of flexor tendon injuries remains frustratingly
unpredictable. This series demonstrates a technique for flexor tendon
and tendon sheath reconstruction.
|Click on each image for a larger picture|
|This patient had undergone
two prior procedures elsewhere for flexor tendon injuries from a
laceration in the proximal phalanx of the middle finger. There was full
passive but no active flexion and fixed flexion contractures of both
the proximal and distal interphalangeal joints.
|At exploration, neither A2
nor A4 pulleys could be identified. PIP and DIP capsulotomies were
required to restore passive extension. Reconstruction was undertaken
a silicone tendon spacer, pulley reconstruction and preliminary flexor
digitorum profundus to superficialis tendon juncture.
|The deep needle is
delivering the tendons into the field. The superficial needle is
maintaining an end to end orientation so that the tendon ends were
approximated without angulation.
|A strip of extensor
retinaculum was used as a graft for pulley reconstruction.
|The retinacular graft was
passed twice around the proximal phalanx in an effort to recreate the
entire A2 pulley.
|The A4 pulley was
reconstructed by bridging the graft to the remaining attachments of the
proper tendon spacer position and no bowstringing.
|Second stage, three months
later. The tendon spacer and the tendon-tendon juncture are exposed:
|The FDS tendon was divided
in the forearm. The proximal stump was delivered into the palm
wound, sutured to the tendon spacer and pulled out the fingertip.
|Tension was adjusted to
match the cascade of the adjacent fingers.
|The distal tendon graft was
brought out the fingertip, and sutured to the old FDP stump.
|That's the easy part! Now it's up to a motivated patient and a dedicated therapist to make it work.|
Flexor tendon reconstruction
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