[Longstanding flexor tendon lesions treated by two-stage tendon graft]

46 fingers in 42 patients undergoing 2-stage flexor tendon grafting for traumatic injury in zone 2 were evaluated with an average follow up of 13 months (range 6 to 120 months). 24 anastomoses between FDS and FDP were performed according to the Paneva Holevitch procedure. In all other cases, palmaris longus or plantaris were used as tendon grafts during the second stage. Proximal fixation was always performed in the palm. 3 or more pulleys were reconstructed in all cases. In 21 cases, pulley reconstruction required the use of excised tendon remnants or retina-culum dorsalis. Distal fixation was performed to the distal phalanx in 42 cases and to the second phalanx in 4 cases, during the second stage. Overall, 85% patients obtained a good or fair result in terms of TAM (total active motion) with <>. 7 cases obtained a poor result. 12 fingers required complementary surgery: --2 cases with poor active flexion had been treated by shortened suture. --3 ruptures of tendon graft required P2 fixation and DIP arthrodesis in distal rupture (2 cases), and anastomosis with next flexor tendon in proximal rupture (1 case). --7 cases of PIP stiffness were treated by PIP arthrolysis. DIP arthrodesis was associated in 2 cases.