Two Stage Flexor Tendon Reconstruction

Introduction: The flexor tendons are part of a very important anatomical-physiological aspect of the hand. A significant number of patients with flexor tendon injury will not benefit from reconstruction by one stage tendon grafting technique and would rather restore their function by staged reconstruction using silicon rod (tendon spacer), followed by a replacement graft. Delayed or neglected flexor tendon injuries, tendon rupture following previous repair, Zone II hand injuries and more, are all indications of staged flexor tendon reconstruction.

Methodology and Material: The technique depends on implanting a silicon rod (tendon spacer) attached to both ends of the injured flexor tendon, to form a tunnel sheath, which then can receive the tendon graft after 10-12 weeks in the second stage to prevent complications such as adhesions that could occur with single stage repair in such cases. Palmaris longus or plantaris are satisfactory tendon graft choices.

Results: White's evaluation criteria was used for postoperative evaluation of the technique which is based on the following parameters: loss of extension, total sum of flexion of the IP and MCP and the pulp-palm distance. 10.5% of cases were considered excellent, 65.8% were good, 18% were fair, and 5.7% were bad.

Conclusions: Reconstruction of the flexor tendons in two stages can significantly improves the function of lesioned fingers presenting extense fibrosis or adherence of the flexor mechanism.