A fresh look at vascularized flexor tendon transfers: concept, technical aspects and results

The authors present the results of their surgical experience based on an original approach in secondary reconstructing 71 flexor tendons of the hand. For 20 years, they have been using vascularized tendon transfers either islanded or as free transfers. Their techniques are based on extensive knowledge of the sliding mechanisms involved around the flexor tendons, for which the authors have developed new scientific explanations resulting from their observations and the fine analysis of movements. This sliding system has a multimicrovacuolar, multifibrillar architecture that is able to accommodate every request for movement. By performing vascularized transfers, the authors also transfer the sliding capability together with the tendon itself, thereby avoiding the two traditional stages of tendon reconstruction. Results are better than with the traditional techniques and the gain in time is considerable. Moreover, the biological and physical advantages of transferring living structures are such that the functional outcome in secondary interventions is much better. Furthermore, the wide variety of transfers available offers possibilities for reconstruction that are better suited to the range of presentations encountered in this challenging area of surgery. This new approach to reconstruction is reserved for complex clinical cases and experienced surgeons.