- See:
-
Excursion, of Tendons
-
Staged Flexor Tendon Repair
-
Tendon Repair Technique
-
Pulley Reconstruction
-
Tendon Sheath Anatomy
- Anatomy:
- on volar aspect of finger,
FDP passes thru
FDS to insert on distal phalanx;
- both long flexor tendons are tightly enclosed in common tendon sheath which corresponds to
zone II;
- this anatomical proximity explains the development of adhesions between FDS & FDP tendons & digital fibrous sheaths following injury;
- Contraindications to Tendon Grafting:
- neglected tendon lacerations more than 6 weeks old;
- severely contaminated wound;
- loss of tendon substance of greater than 1.5 cm
- loss of the A2 pully, the A4 pulley, or both;
- if wound is contaminated delayed repair (10 days) is possible w/ good results;
- Tecnique:
- graft bed is prepared prior to harvest of the donor tendon;
- remaining portion of the profundus tendon is resected to the mid palm level;
- 1 cm of the distal profundus stump is saved to further augment distal graft anchorage;
- donor tendon:
- donor tendon should not be larger than FDP since this will overcrowd the tendon sheath;
- usual donor tendons include:
palmaris longus,
extensor indicis, and central
toe extensors;
- never use a donor tendon w/ a longitudinal split (such as from the FCR) since this will cause adhesions;
- tendon is passed through the tendon sheath either through the FDS chiasm or around it;
- anchor distal end of tendon graft first (see
pull through technique);
- proximal tendon graft anchorage:
-
optimizing graft tension
- pulvertaft weave is utilized;
- do not incorporate lumbricals into the repair;
- Post Operative Care
Bridge flexor tendon grafts.
Angiogenesis in healing autogenous flexor-tendon grafts.
Autogenous flexor-tendon grafts. A biomechanical and morphological study in dogs.
Work of flexion after flexor tendon repair according to the placement of sutures.
