1. Intrasynovial tendon grafting for finger flexor tendon reconstruction
Hiroyuki Ohi. MD
Hand & Microsurgery Center, Seirei Hamamatsu General Hospital, Hamamatsu, JAPAN
Purpose:
　Tendon grafting to the digital sheaths of the hand sometimes dose not good results. One factor affecting the results may that the grafts are usually from extrasynovial tendons such as palmaris longs or plantar is tendon. The aim of this study was analysis the outcomes intrasynovial tendon grafting harvested from toe flexor for secondary flexor tendon reconstruction.
Material & Methods:
・Cases: 7 patients 7digits ( ) thumb, 1 index finger, 1 middle finger, 2 ring finger, 1 little finger
・Age: av yo (24-59)
・Donor tendon: Second or third toe flexor tendon
・Flexor reconstruction: One staged (4 digits), two staged (3 digits)
・Suture method: Distal end; Direct suture to base of distal phalanx. Proximal site; Pulvertaft weaved suture.
・Surgery: The operations were performed by only one surgeon (author).
・Rehabilitation: Early active exercise (same protocol).
Operative methods: (24yo. Male, lt-ring finger, 2 staged tendon reconstruction case)
active extension
active flexion
passive flexion
Before tendon grafting, ROM
Tendon grafting (donor: 3dtow flexor)　
3d toe flexor
ring finger
donor: 3d toe flexor
direct suture
FDP
donor: 3d toe flexor
3d toe flexor
plantar
Pulvertaft weaved suture
4-0 looped Fiber Wire
Postoperative rehabilitation:
　Early active flexion and extension exercise
　with dorsal extension block splint.
10 mos PO, ROM
active extension
active flexion
index finger (other case): 2wks PO
%TAM: 90.2%, Recovery rate: 92.0%
Results:
　Finger TAM: av. 92.0% ( ),　Recovery rate was 94.2% ( )
Complications:
・No tenolysis case.
・One patient failed at the proximal suture site in the palm associated with infection at 3 weeks. Three months later,
I transferred the ring flexor tendon (FDS) to the proximal stump of the grafted tendon in the palm.
・All patients had residual limited flexion of the donor toe. However, gate was apparently normal.
Discussion:
　Our preliminary report of intrasynovial tendon grafting for flexor tendon reconstruction from 2009 to 2014 was performed two institutes, 3 surgeons and no same rehab protocol. In conclusion, this technique gives a good result when successful but with a high complication rate＊. 　
　This study was performed one surgeons and early mobilization. The results of this study suggested much better results than our preliminary reports.
　The biological and biomechanical properties of the intrasynovial tendon are superior to those of the extrasynovial tendon for grafting into the synovial space. Early mobilization less occur adhesion. I thought this two factors makes good results.
　TAM of our primary flexor tendon repair (zone 2, 31 digits) was av. 94.0% ( ). There was no difference of results between this study and primary repair case.
Conclusions:
　This technique is feasible and gives a better result.
＊H. Ohi, S. Uchiyama, et al.: Outcomes of grafting intrasynovial tendons of the toes to the hands in 10 patients: a preliminary report. JHS(E) 42: , 2017