Outcomes of grafting intrasynovial tendons of the toes to the hands in 10 patients: a preliminary report

Ohi, Hiroyuki; Uchiyama, Shigeharu; Kanda, Toshihiro; Mukoda, Masashi; Hayashi, Masanori; Kato, Hiroyuki

doi:10.1177/1753193417691653

Cited by 3 publications

(4 citation statements)

References 27 publications

(31 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In recent years, early active mobilization has been recommended after tendon grafting. 14 , 15 , 16 , 17 , 18 Our results are consistent with prior series with rupture rates of 0% to 27%, recovery rates of 59% to 84%, and AROM at the final visit of 96° to 136° ( Table 4 ). Theoretically, early active mobilization after flexor tendon grafts could decrease adhesion formation and improve patient outcomes compared with immobilization or the Kleinert technique.…”

Section: Discussionsupporting

confidence: 91%

“…26e28 Gelberman et al 29 suggested that the unique angiogenic response of intrasynovial flexor tendon grafts may allow healing with only minimal ingrowth of vascular adhesions. Recently, free-tendon grafting using intrasynovial donor tendons was performed in an effort to reduce adhesion formation 16,17 ; however, the clinical results seem to be similar to those obtained after extrasynovial tendon grafting (Table 4). Compared with intrasynovial tendons, the weak point when using extrasynovial tendons as free grafts is likely to be the grip of the sutures at the distal tendonebone junctions.…”

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

Flexor Tendon Grafting Using Extrasynovial Tendons Followed by Early Active Mobilization

Moriya¹,

Yoshizu²,

Maki³

2020

Journal of Hand Surgery Global Online

View full text Add to dashboard Cite

This study evaluated the outcomes of early active mobilization after flexor tendon grafts using extrasynovial tendons with a novel distal fixation technique. Methods: This study was a retrospective case series. The flexor digitorum profundus (FDP) tendons of 7 digits in 7 patients were reconstructed with extrasynovial tendons, which included the palmaris longs, plantaris, and extensor digitorum longus, in a single-or 2-stage procedure between 2008 and 2017. Of the 7 patients, 6 were male and the average patient age was 48 years. The injuries involved 2 middle, 2 ring, and 3 little fingers. The tendons were sutured into the appropriate FDP tendon proximally using end-weave anastomosis; the distal end of the graft was fixed to the distal stump of the FDP using an interlacing suture or a small bone anchor combined with the pull-through technique. The digits were mobilized with a combination of active extension and passive and active flexion in a protective orthosis during the first 6 weeks after surgery. Average follow-up was 18 months. We measured active and passive digit motion both before tendon grafting and at the final evaluation. Outcomes were graded by the LaSalle formula to assess staged flexor tendon reconstruction. Results: Average passive range of motion (ROM) of the proximal and distal interphalangeal joints before flexor tendon grafting was 146 (SD, 22). Mean active ROM of these joints at the final evaluation was 123 (SD, 34). Using the LaSalle formula, mean recovery of active motion was 83%. We encountered no grafted tendon rupture and no finger required tenolysis. Conclusions: Our proximal and distal fixation techniques allowed the autologous extrasynovial tendon grafts to withstand the stress encountered during early active mobilization with good postoperative ROM and minimal complications. Type of study/level of evidence: Therapeutic I.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 96%

Flexor Tendon Grafting Using Extrasynovial Tendons Followed by Early Active Mobilization

Moriya¹,

Yoshizu²,

Maki³

2020

Journal of Hand Surgery Global Online

View full text Add to dashboard Cite

show abstract

“…However, it should be noted that the majority of cases in the case series reported here did not have any pulley reconstruction, and the gliding sheath was intact, which is different from those previous series of two-stage tendon reconstruction. The case series presented by Ohi et al (2017) had a similar functional return to the patients in this report. We believe that our technique results in functional return similar to a one-stage tendon graft, but we cannot state that this will be an alternative to two-stage tendon reconstruction.…”

Section: Discussionsupporting

confidence: 71%

Results of heterodigital flexor digitorum profundus hemi-tendon transfer for 23 flexor tendon injuries in zones 1 or 2

Bommier

McGuire

Boyer

et al. 2017

J Hand Surg Eur Vol

View full text Add to dashboard Cite

show abstract

“…58,59 No direct comparison has demonstrated the superiority of intrasynovial to extrasynovial grafts. 60,61 The most commonly used donor grafts are the extrasynovial palmaris longus or plantaris tendons.…”

Section: Source Of Donor Tendonmentioning

confidence: 99%

Secondary Procedures following Flexor Tendon Reconstruction

Gillis

Moran

2021

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

he incidence of flexor tendon injury is 33 injuries per 100,000 person-years. 1,2 Advancements in flexor tendon repair, including wide-awake surgery, have led to improved outcomes. 3 In studies using multiple strand repairs and active range of motion, excellent results (defined as total active range of motion more than 150 degrees 4 ) have been noted in up to 86 percent of cases. 5,6 Despite this, reoperation still occurs. In a retrospective review of 5229 patients undergoing primary flexor tendon repair, there was a 6 percent reoperation rate, with 58 percent of these patients requiring tenolysis alone, 38 percent requiring rerepair alone, and 4 percent requiring both. 7 In such cases, the surgeon must have an understanding of the available reconstructive options for the treatment of patients with neglected, failed, or scarred tendon repairs. This article will review the indications and management options for failed flexor tendon surgery. THE MECHANICAL IMPACT OF FAILED FLEXOR TENDON REPAIRComplications following flexor tendon repairs include decreased range of motion, tendon bowstringing, quadriga, and lumbrical-plus deformity. 8-10 Compared to patients with primary flexor tendon repair, who have a mean QuickDASH score of 19.3, patients who require two-stage tendon reconstruction have a mean QuickDASH score of 34.4, emphasizing the importance of successful primary repair. 11 Flexor tendon pulley injury and tendon bowstringing can contribute to poor results. The pulley system consists of several fibro-osseous tunnels that run from the metacarpal head to the distal interphalangeal joint. These tunnels hold the tendons close to the joint's axis, allowing maximal motion for small amounts of tendon excursion. Biomechanical cadaver studies show an 8.5 percent increase in tendon excursion with loss of the A2 pulley, a 9.9 percent increase with loss of the A4 pulley, and a 33.7 percent increase with loss of both A2 and A4. 12 The loss of both pulleys leads to a 107 percent increase in the work of flexion. 12 This can lead to loss of motion and joint contracture. Pulley damage can be avoided by accessing and performing the tendon repair through the cruciate pulleys. Recent reports have shown that

show abstract

Outcomes of grafting intrasynovial tendons of the toes to the hands in 10 patients: a preliminary report

Cited by 3 publications

References 27 publications

Flexor Tendon Grafting Using Extrasynovial Tendons Followed by Early Active Mobilization

Flexor Tendon Grafting Using Extrasynovial Tendons Followed by Early Active Mobilization

Results of heterodigital flexor digitorum profundus hemi-tendon transfer for 23 flexor tendon injuries in zones 1 or 2

Secondary Procedures following Flexor Tendon Reconstruction

Contact Info

Product

Resources

About