Staged Tendon Reconstruction
Staged tendon reconstructions are indicated for delayed or neglected flexor tendon injuries and tendon rupture following previous attempted repair if the fibro-osseous tunnel has significantly contracted and is not amenable to primary tendon grafting. It is contraindicated in isolated flexor digitorum profundus (FDP) injuries with an intact flexor digitorum superficialis (FDS) as attempted reconstruction of the FDP may result in worse digital flexion function and in such cases tenodesis of the FDP or distal inter-phalangeal joint fusion (arthrodesis) should be performed instead. A supple digit with full passive flexion is essential prior to any attempt at flexor tendon reconstruction.
Palmaris longus is marked out for one tendon graft, likely the little finger since it will require a shorter graft than the ring finger. The plantaris tendon or second toe extensor will be harvested for the ring finger.
Harvesting the palmaris longus tendon. Also, isloation of the distal end of the silicone tendon spacer and distal profundus tendon stump is achieved through a small Brunner incision at the distal interphalangeal joint.
The proximal ends of the silicone tendon spacers are identified and the tendon grafts are sutured to them so they can be withdrawn at the distal interphalangeal joint level passing the tendon grafts in place of the spacer in the new synovial lined flexor sheath.
The grafts are attached to the distal phalanx and profundus tendon stumps first. Then the proximal tendon junctures are made between the grafts and the profundus tendons of the index and middle fingers as the proximal motor at appropriate tension to allow full digital flexion of all digits.