Two-stage reconstruction of the flexor tendons

Area of Science:

• Hand surgery
• Orthopedic surgery
• Reconstructive surgery

Background:

• Secondary flexor tendon repair is challenging, especially in the critical zone.
• Previous methods like two-stage tenoplasty with pedicle grafts have variable success rates.
• Stiff and scarred fingers present unique difficulties in tendon reconstruction.

Purpose of the Study:

• To evaluate the effectiveness of a two-stage tenoplasty with a pedicle graft for secondary flexor tendon repair.
• To assess the added benefit of the Hunter procedure with a silicone rod in stiff and scarred fingers.

Main Methods:

• A retrospective review of 324 secondary flexor tendon repairs using two-stage tenoplasty with pedicle grafts.
• A subgroup of 39 repairs combined with the Hunter procedure (silicone rod) for stiff and scarred fingers.
• Comparison of outcomes between standard tenoplasty and the combined approach.

Main Results:

• The combined Hunter procedure significantly improved very good results from 13.8% to 47.8% in scarred fingers.
• However, outcomes in stiff fingers treated with the silicone rod remained poor.
• The overall success rate for secondary flexor tendon repair varied based on finger condition.

Conclusions:

• The Hunter procedure with a silicone rod is beneficial for secondary flexor tendon repair in extensively scarred fingers.
• This combined approach shows limited efficacy in improving outcomes for stiff fingers.
• Further research is needed to address challenges in reconstructing stiff, scarred flexor tendons.