Surgical outcome of one-stage and two-stage flexor tendon grafting in children

Flexor tendon grafting represents the most common modality for secondary restoration of flexor tendon function. Tendon grafting is either performed in 1 or 2 stages. This study attempts to evaluate the clinical outcome of 1-stage and 2-stage grafting in children.

A retrospective review was performed identifying 20 children treated for secondary rupture of the flexor digitorum longus by means of a tendon graft. There were 17 boys and 3 girls with a mean age of 10.8 years (range: 3 to 15) at the time of surgery. The preoperative condition of each operated finger was graded by the digital damage classification recommended by Merle and Dautel. Functional status was obtained throughout follow-up using the Strickland classification.

There were 10 children in grade 1, 6 grade 2, and 4 grade 3 according to Merle and Dautel classification. The delay between the initial trauma or primary procedure and the secondary surgical procedure averaged 7.5 months for 1-stage grafting and 9 months for 2-stage grafting (range: 1 mo to 2 y). The median Strickland index was 70 (range: 55 to 114) for 1-stage grafting and 66 (range 0 to 103) for 2-stage grafting, which was not statistically different (P=0.1).

The functional outcome seems to depend on the initial severity index. One-stage grafting is a relevant procedure when pulleys are intact and the range of motion is complete. When neurovascular bundles are injured a 1-stage grafting should not be tempted. Satisfactory results are expected with 2-stage grafting providing the principles of this procedure are carefully adhered to.

Level 4.