Jaleel, H., Al-Qasem, M. (2024). The Use of “Extended Flexor Tendon Graft” in the Repair of Delayed Flexor Tendon Injury Instead of the Traditional Technique; A Comparative Study. , 23(1), 3-6. doi: 10.52573/ipmj.2024.182792
Haider H. Jaleel; Marwan M. Al-Qasem. "The Use of “Extended Flexor Tendon Graft” in the Repair of Delayed Flexor Tendon Injury Instead of the Traditional Technique; A Comparative Study". , 23, 1, 2024, 3-6. doi: 10.52573/ipmj.2024.182792
Jaleel, H., Al-Qasem, M. (2024). 'The Use of “Extended Flexor Tendon Graft” in the Repair of Delayed Flexor Tendon Injury Instead of the Traditional Technique; A Comparative Study', , 23(1), pp. 3-6. doi: 10.52573/ipmj.2024.182792
Jaleel, H., Al-Qasem, M. The Use of “Extended Flexor Tendon Graft” in the Repair of Delayed Flexor Tendon Injury Instead of the Traditional Technique; A Comparative Study. , 2024; 23(1): 3-6. doi: 10.52573/ipmj.2024.182792

The Use of “Extended Flexor Tendon Graft” in the Repair of Delayed Flexor Tendon Injury Instead of the Traditional Technique; A Comparative Study

Iraqi Postgraduate Medical Journal
Article 2, Volume 23, Issue 1, January 2024, Pages 3-6    PDF (220.5 K)
DOI: 10.52573/ipmj.2024.182792
Authors
Haider H. Jaleel* ; Marwan M. Al-Qasem
Al-Yarmook Teaching Hospital Baghdad, Iraq.
Abstract
ABSTRACT:
BACKGROUND:
Flexor tendons repair outcome depends on meticulous surgery built upon a thorough  knowledge  of  the  anatomy  and  biomechanics  of  the  flexor  tendon system.  Direct tendon repair is the standard method with most rewarding outcome. Still at times where direct repair is impossible because of  large defect or sever adhesions, extra synovial tendon graft is considered. Attachment of the distal       end of the graft at the insertion of the flexor digitorum profundus into the distal phalanx has been                 a matter of controversy.
OBJECTIVE:
Compare between the traditional way of attaching the distal end of the graft to the  stump  of                     the  flexor  digitorum  profundus  tendon,  with  an  alternative  “extended  graft“  technique  that  involves  attaching  the  distal  end  to  the  distal phalanx through a pull-out suture.
PATIENTS AND METHODS:
Twenty-six  patients  included  in  this  study,  21  case  of  injury  to  the  flexor digitorum profundus and 5 involving the flexor pollicis longus. A mean age of patients of 29 years. All injuries presented late (more than 3 months). All cases reconstructed in Two-stage procedure of Hunter-Salisbury using silicone rod in the first stage, followed by replacement by Palmaris longus tendon graft in the second stage. Patients are divided into 2 groups ; first which included 15 case where the traditional methods used ; that is attaching the distal end of the graft to the stump of the ruptured flexor tendon, and in               the second group the technique of ‘’ Extended graft ‘’, where the graft is attached by a pull-out suture to the distal phalangeal bone.
RESULTS:
Two  groups  of  patients  studied,  fifteen  case  in  the  first  group  where  the traditional method of repair used, and the ‘’extended technique’’ used in eleven case, the second group. In the first, more than 50% of DIP flexion lost, whereas in the second group, more than 90% of DIP flexion preserved.
CONCLUSION:
We concluded that using the “extended graft” technique can markedly reduce the stiffness in the distal interphalangeal joint and thereby the loss of flexion that result from the traditional method.
 
Keywords
Flexor digitorum profundus; Palmaris longus; silicon rod; two-stage tendon repair
References
  1. Rosberg HE, Dahlin LB. Epidemiology of hand injuries in a middle-sized city in southern Sweden: a retrospective comparation of 1989 and 1997. Scand J Plast Reconstr Surg Hand Surg. 2004;38:347-55.
  2. Tang JB, Amadio PC, Boyer MI, Savage R, Zhao C, Sandow M, Lee SK, Wolfe SW. Current practice of primary flexor tendon repair: a global view. Hand Clin. 2013 ;29:179-89. Epub 2013 Apr 3.
  3. Xuan Qiu. Kevin C. Chung. Grabb and Smith Plastic Surgery, 8th edition, ch. 76.
  4. Strickland JW. Results of flexor tendon surgery in zone II. Hand Clin. 1985;1:167-79.[6].
  5. Tang JB. Clinical outcomes associated with flexor tendon repair. Hand Clin. 2005;21:199-210.[7]
  6. Paneva-Holevich E. Two-stage tenoplasty in injury of the flexor tendons of the hand. J Bone Jt Surg Am 1969;51:21-322.
  7. 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 Am 1971;53:829-58.
  8. Jakubietz MG, Jakubietz DF, Gruenert JG, Zahn R, Meffert RH, Jakubietz RG. Adequacy of palmaris longus and plantaris tendons for tendon grafting. J hand surg Am. 2011;36:695-98.
  9. Samuel R, Carolina M. Felipe M. The Abductor pollicis longus tendon as an alternative graft in hand surgery. J Hand Surg Am. 2016.
  10. Brunelli G, Monini L. Technique personnelle de suture des tendons flechisseurs des doigts avec mobilization immediate. Ann Chir Main. 1982;1:92-96.
  11. Alexandru V.G., Ileana R.M., Irina M.C., Filip A., Octavian D.O. Modified Brunelli pull-out technique in flexor tendon repair for zone II : a study on 58 cases.
  12. Leddy JP, Packer    Avulsion  of  the  profundus  tendon  insertion  in athletes. J  hand  Surg1977;2:66-69.
  13. Idle RS. Anatomy and biomechanics of the digital flexor tendons. Hand clin 1985;1:3-11.
  14. Doyle JR, Blythe WF. Macroscopic and functional anatomy of the flexor tendon sheath. J bone joint surg Am 1974;56:1094.
  15. Le Viet D. Flexor tendon lengthening by tenotomy at the musculotendonous junction. Ann PlastSurg1986;17:239-46.
  16. Zhang J., Lei P., Yun F. Outcome of digital flexor tendon repairs using updated protocol and 30 repairs using an old protocol: experience over 7 years; Journal of Hand Surgery ( European Volume ) 2020; 4: 56-63.
  17.  
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