Reconstruction of the Old Flexor Tendon Injury in the Hand / 대한정형외과학회잡지

The old flexor tendon injury in the hand seen after 4 weeks from damage and associated with crushing injury, heavy scarring, fracture and infectious state has the difficulty to deliver the flexor tendon through fibro-osseous sheath and the pulleys. Treatment method depends on the circumstances of the injured flexor tendon and surgeons' judgement. We have treated twenty-three fingers of twenty-three cases, who had old flexor tendon injury, by advancement and tenolysis in 1 each, tendon graft in 5, and staged tendon graft in 16 from March 1989 through February 1994. The result was summarized as follows. 1. The old flexor tendon injury most commonly occurred in the fifth finger(11 cases, 47.8%)and in zone II (16 cases, 69.6%). 2. The most common cause was glass injury(15 cases, 69.6%). 3. 21 of 23 cases(2 thumbs excepted)were evaluated according to the original Strickland system. 14 cases of the staged tendon graft showed excellent(6 cases, 42.9%), good(5 cases, 35.7%)and fair(3 cases, 21.4%). 5 cases of the tendon graft showed excellent(2 cases, 40%), good(1 case, 20%), and fair(2 cases, 40%). 1 case of adhesiolysis and 1 case of advancement showed excellent and good results each. Little difference is observed in the method between the staged graft and tendon graft. 4. The degree of the associated soft tissue injury should be evaluated by the experienced hand surgeon before surgery and the delicate balance between protection and mobilization during the postoperative weeks is important as well as the surgical skill.

Clinical Study on the Staged Tendon Graft for Flexor Tendon Injury of the Hand / 대한정형외과학회잡지

The biological characteristic of the silastic rod which in vivo induce the pseudosheath formation has popularized its application in the reconstructive surgery of flexor tendon injury of the digit, especially in the zone I, no-man's-land. We performed staged tendon graft in 14 digits(9 cases) and the following were the results. Clinical results of the 13 digits were good in 10 digists(77%). One case showed the untoward ill effect postoperatively. The above study has also shown that this staged tendon graft operation is applicable even to the higher grade of injury by Boyes. For the prevention of bowstring effect, A2 and A4 pulleys seem to be more essential than A1, A2. and A3.