Staged flexor tendon reconstruction fingertip to palm

Thirty-five fingertip to palm staged flexor tendon reconstructions were performed between 1971 and 1998. Tendon injuries involved 5 avulsions and 30 lacerations, 9 of which had failed primary tenorrhaphies. Follow-up evaluation averaged 30 months. Thirteen patients had total active motion (TAM) of > or =220 degrees (excellent), 11 patients had TAM of 200 degrees to 219 degrees (good), 7 patients had TAM of 180 degrees to 199 degrees (fair), and 4 patients had TAM of <180 degrees (poor). Less favorable results occurred in those with a >1-year interval between injury and stage I, in those with a >6-month interval between stage I and stage II, and in those with a higher injury severity classification. Fingertip to palm staged flexor tendon reconstruction produced 69% good to excellent results. This technique allows the use of the injured digit profundus as the motor, preserves lumbrical function, and requires less tendon graft length (palmaris longus usually suffices).