Pull Thru Technique for FDP Reinsertion

- Discussion:
    - in the case of FDP laceration, if cut is less than 1 cm from insertion, consider tendon advancement and reinsertion;
    - raise osteo-periosteal flap in distal phalanx, which is just distal to volar plate;
          - damage to the volar plate may lead to DIP flexion contracture;
          - in contrast, overly distal tendon insertion will also result in flexion contracture;
    - pass 3-0 prolene through distal edge of tendon in a Bunnel weave pattern;
    - drill a small hole through the middle of the distal phalanx which exit thru the mid aspect of nail (through sterile matrix);
    - using Keith needle, pass these both suture arms through the drill hole;
    - tie the prolene over felt and a button;
    - multiple strand repairs are stronger than single strand repairs;
    - suture anchors:
          - as noted by Silva, et al (1998), suture anchors had significant weakness as compared to the dorsally placed button;
    - post operatively, the prolene can be pulled out after tendon healing has occurred

The effects of multiple-strand suture techniques on the tensile properties of repair of the flexor digitorum profundus tendon to bone.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, December 21, 2012 2:40 pm