Authors
1
Ministry of Health, Shrine Karbala Health Directorate, Al-Hassan Al-Mujtaba Teaching Hospital.
2
Consultant Pediatric Surgeon, Baghdad University, College of Medicine., Baghdad, Iraq
,
Document Type : Research Paper
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.
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