Alternate Graft Options for Staged Flexor Tendon Reconstruction: A Cadaveric Study of Hamstring Autografts Compared to Conventional Autografts

PURPOSE

To compare the semitendinosus and gracilis tendon lengths and diameters to the palmaris longus, plantaris, flexor digitorum profundus, and flexor pollicis longus (FPL) tendons in a cadaveric model to evaluate the feasibility of hamstring autograft use for staged flexor tendon reconstruction.

METHODS

Fifteen fresh cadavers were evaluated for surgical incisions about the knee, forearm, and hand. All flexor digitorum profundus (FDP), FPL, palmaris longus, plantaris, semitendinosus, and gracilis tendons were harvested from each specimen. Diameter and length were recorded and means with SDs were calculated. The mean diameters of the gracilis and semitendinosus were compared to the mean diameters of the FDP and FPL tendons. The hamstring tendon lengths were then compared in terms of percentage of the palmaris longus and plantaris tendon lengths.

RESULTS

The gracilis (18.0 cm) and semitendinosus (19.9 cm) means were notably longer than the palmaris longus (16.0 cm) and shorter than the plantaris (30.0 cm). The average gracilis tendon diameter (3.8 mm) was smaller than the flexor tendon diameters except for the little finger FDP (3.8 mm). The semitendinosus tendon diameter (4.8 mm) was larger than all flexor tendons with the exception of the middle finger FDP (4.6 mm). Average gracilis and semitendinosus tendon diameters were 3.7 mm and 4.5 mm in males, and 3.8 mm and 4.8 mm in females.

CONCLUSIONS

This study showed the gracilis tendon to have adequate length and diameter for potential autograft use in staged flexor tendon reconstruction in all digits but the little finger. The semitendinosus is larger in diameter than the native flexor tendons, making it a poor autograft option in cases with an intact pulley system.

CLINICAL RELEVANCE

Common tendon autograft options for flexor tendon reconstruction are variably present, and the use of gracilis and semitendinosus autograft present potential graft options.

Reconstruction using vascularized extensor indicis proprius tendon

The choice of the donor tendon in tendon reconstruction of the hand theoretically influences the results of the surgery because of the interactions of its structure with the healing process. The objective of our study was to specify the surgical bases of vascularized extensor indicis proprius (EIP) in tendon reconstruction of the hand and to present its application from a series of observations. According to our observations, the EIP's vascularization arises from a branch of the 2nd dorsal metacarpal artery, 3-4 cm proximally to the metacarpophalangeal joint (MCP). We demonstrate the feasibility and effectiveness of a vascularized EIP graft for finger flexor tendon reconstruction, for defects of the extensor mechanism at the MCP joint level and for reconstruction of the extensor pollicis longus. Our biomimetic approach in tendon reconstruction has led us to factor in the complexity of the tendon and peritendinous structure. The use of vascularized EIP offers theoretical advantages for the tendon healing process, demonstrates encouraging first results with interesting versatility and very low iatrogenicity.

Ordinary PVC feeding tube: A low-cost alternative to silicon rod for staged flexor tendon reconstruction in zone II of hand

BACKGROUND

Staged flexor tendon reconstruction is most appropriate treatment for delayed zone II flexor tendon injuries of hand. The Hunter's silicon rod used in this procedure is costly and not simply available. The aim of this study was to evaluate the results using PVC feeding tube as a cheaper and readily available alternative.

MATERIALS AND METHODS

this study include 6 patients(8 digits) were treated by the staged flexor tendon reconstruction using PVC feeding tube for first stage followed by tendon graft in second stage and the patients were followed for mean period of 6 months.

RESULTS

Excellent results were seen in 5 digits and good results in 3 digits, according to both LaSalle system and Strickland-Glogovac grading system.

CONCLUSIONS

PVC feeding tube is a cost effective, simply accessible and an effective alternative to Hunter's silicon rod for staged flexor tendon reconstruction.

An alternate graft for staged flexor tendon reconstruction

We describe the novel use of semitendinosus as a tendon graft for 2-stage flexor digitorum profundus (FDP) reconstruction. To our knowledge, this is the first reported use of a hamstring tendon graft in this setting. The FDP of two digits were reconstructed in a 30 year-old male who presented 18 years after the original injury. The semitendinosus was chosen as a graft as the traditional grafts were deemed inappropriate. The result of the operation is convincing, and we suggest the semitendinosus tendon to be considered an option for FDP reconstruction.