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.