The by-pass extensor tendon transfer. A salvage technique for loss of substance of the extensor apparatus in long fingers.

A salvage technique for the treatment of substance loss of the extensor apparatus with some special features is presented. It uses the extensor indicis muscle prolonged with a tendon graft. The tendon is directly attached to the middle phalanx. After surgery, the wrist is immobilized in extension, allowing immediate active mobilization of the PIP joint. The results in five patients are satisfactory.

[Fresh sections of the flexor tendons of the fingers and thumb. New therapeutic trends. Apropos of a clinical series of 77 tendon lesions]. / Sections récentes des tendons fléchisseurs des doigts et du pouce. Orientations thérapeutiques nouvelles. A propos d'une série clinique de 77 lésions tendineuses.

In flexor tendon surgery, the main concern of hand surgeons in the last two decades has been to find an effective and reproducible means to avoid post-operative adhesions. For most authors, these adhesions were responsible for the bad results. Since 1960, a constant progress has been achieved with the progress in operative procedures and the better understanding of tendon healing process. Post-operative rehabilitation, especially Kleinert's and Duran's active and passive methods, have radically transformed the prognosis of fresh tendon lesions. In spite of all this progress, zone II tendon injuries are still a difficult problem. In this clinical study, we wanted to introduce two new orientations in order to improve the overall results, the use of human fibrin sealant instead of the epitendinous running suture and an improvement of Duran's technique, developed by the Bichat rehabilitation team since 1987. Seventy-seven tendon lesions treated according to our technique (55 fingers and 22 thumbs) between 1987 and 1991, were reviewed. All the lesions studied were in zone II and T II. The mean follow-up is 14.4 months. The evaluation is based on the International Federation of Hand Surgery score for fingers, and the Tubiana score for thumbs. 74% of fingers and 86% of thumbs were scored as good and excellent.