Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca

Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca

Kazuistika / Case report

ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE ČECHOSL.,
85, 2018, p. 370 - 372

Možnosti ošetření u zastaralých poranění hlubokých flexorů prstů ruky - primární transplantace šlachovým štěpem

Treatment Options for Inveterate Injuries of Deep Finger Flexors - Primary Transplantation with Tendon Graft

A. SUKOP1, P. TICHÁ1, M. MOLITOR2
1 Klinika plastické chirurgie 3. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha
2 Klinika plastické chirurgie 1. lékařské fakulty Univerzity Karlovy a Nemocnice na Bulovce, Praha

SUMMARY

Injuries of the flexor finger apparatus are very common. Primarily, it is routinely treated by suture of the tendon. Isolated deep flexor injuries, when the flexion restriction only reaches the DIP joint, are sometimes overlooked by the surgeon or by the patients themselves, especially if the deep flexor is injured, after a closed rupture or cutaneous injury with a small skin wound. The patient is then sent to a department specializing in hand surgery after a  few weeks. Subsequent shortening of the tendon apparatus makes flexor suture more difficult or sometimes even impossible.

Many ways of suturing the tendons and subsequent treatment are described.

The treatment results vary immensely. It depends on the mechanism of injury, injury zone, the suture suture technique used, time that has elapsed since primary treatment, surgeon experience and subsequent postoperative and rehabilitative care.

One of them is reconstruction of the flexor apparatus by primary transplantation of an autologous tendon graft. Most commonly, the tendon graft is taken from the palmaris longusixom the same hand.

The tendon graft can subsitute the entire area of zones I and II. The tendon suture is made in the palm proximal to the A1 pulley outside the tendon sheath in the area where the muscular belly of the lumbricalis is located on the tendon of the deep flexor. The distal end is reinserted to the base of the distal phalanx.

The primary use of the autologous tendon graft can be used in the reconstruction of obsolete deep-flexor injuries in Zone II, but also in primary treatments. This type of treatment has a number of advantages. Performing the reinforcement of the tendon at the base of the distal phalanx and the suture in the palm of the hand completely eliminates the complications caused by the tendon suture in zone II. There is no injury to the tendon sheath, or the need for intersection of the tendons. The transplanted tendon is smaller in diameter than the deep flexor, so it can also be used for older injuries when the tendon sheath is in partially missing. It removes painful palmar resistance by restoring the right position and a tension of tendon of lumbricalis and the tendon of the deep flexor. This type of reconstruction allows immediate active or semi-rehabilitation of the hand and fingers.

Key words: tendon, injury, hand, transplantation, surgery, flexor, reconstruction, rupture, treatment

Zpět


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