Flexor-tendon grafts in the less-than-optimum situation

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Reconstructive Surgery

Background:

• Flexor tendon injuries often present complex challenges.
• Optimal tendon grafting outcomes can be compromised by factors like joint stiffness, scarring, prior surgeries, nerve damage, or multiple traumas.

Purpose of the Study:

• To evaluate the functional outcomes of flexor tendon grafts in patients with suboptimal conditions for grafting.
• To assess the degree of motion gained in different finger joints and its impact on overall hand function.

Main Methods:

• A retrospective review of forty-six flexor tendon grafts performed in forty-one patients.
• Analysis of patient cases with pre-existing complicating factors such as joint stiffness, scarring, previous grafting, nerve damage, or severe polytrauma.

Main Results:

• Significant improvement in proximal interphalangeal (PIP) joint flexion was observed.
• Limited gains in distal interphalangeal (DIP) joint flexion were noted.
• Flexion gains in the thumb were less critical if intrinsic muscle function was preserved.
• The contribution to overall hand function was deemed more important than isolated joint motion.

Conclusions:

• Flexor tendon grafting can yield beneficial functional recovery in severely injured hands, even with complicating factors.
• Grafting is most effective for improving PIP joint motion.
• Functional assessment should prioritize the overall contribution to hand function over specific joint range of motion.