Two stage flexor tendon reconstruction: experience on 11 cases

Abstract

Secondary surgery of the flexor tendons of the hand is a very common entity in traumatology and carries significant risks up to total functional impotence. This justifies the importance of the quality of this surgical repair which must be carried out under better conditions, with good anatomical knowledge. Our work is a retrospective study of 11 patients who underwent secondary hand flexor tendon repair during the period of 8 years. The age of the patients varies between 18 and 61 years, with an average of 40 years and a notable male predominance (9 men and 2 women). Assault with a sharp object was the predominant etiology. The right side was the most common in our patients (9 patients). The average time taken to treat (heal) patients was 7 months; with a delay between the two operating times of one month on average. All patients had received a two-fold hand flexor tendon repair. According to Hunter, the tendon spacer that was used in for all our patients was a Redon drain or naso-gastric tube. The small palmar muscle was the tendon graft used in 8 patients. As for the small plantar muscle, it was used in a single patient because of the absence of the small palmar muscle. Moreover, in 2 patients the small palmar muscle was used in association with the superficial common flexor tendon. The functional results of our series were evaluated according to the La Salle and Strickland score, with 20% excellent results, 30% good results, 40% average results and only 10% poor results. Among the rare complications noted in our patients, there was a single case of digital stiffness noted in a single patient, a case of blockage of the graft in a patient and a case of bow string effect. Flexor tendon reconstruction using two stage tendon reconstructions is an effective way to restore digital tendon function in delayed zone II flexor tendon injuries.

Keywords

• flexor tendon injury
• tendon graft
• staged tendon reconstruction