gms | German Medical Science

Objectives/Interrogation: The management of the spastic hand remains a surgical challenge, especially for the cases with severe shortening of the flexor and a marked lack of transferrable muscle-tendon units. In order to achieve a significant elongation of the finger flexors and simultaneously provide enough thumb abduction, a modified flexors harvest technique can be used, where the flexor digitorum superficialis is transferred to the flexor digitorum profundus tendon.

Initially introduced by R. Brown, this technique in Russian tradition is strongly associated with G. Epstein and V. Rosov, who described this surgical procedure with minor differences.

Methods: We suggest the use of a modified technique in this surgery: the tendons of the flexor digitorum superficialis are cut at the proximal falanx level, and then their distal ends are used for the PIP tenodesis. The proximal ends are sutured with the distal ends of the FDP, that are cut near the carpal ligament. And finally, the proximal parts of the FDP can be used as a motor unit for the transfer. If we may need additional strength in the thumb abduction after its contracture release, we can suture the ends of the FDP to the EPL or the EPB, or anchor the FDP to the 1st metacarpal bone. Two patients, one male and one female, both showing some after-effects of a brain injury with spastic hemiparesis, underwent the procedure.

Results and Conclusions: In the first case, enough finger extension to satisfactorily release the grip and perform thumb adduction was achieved. As per the second case, thumb abduction was attained only due to the tenodesis effect of the FDP attached to the 1st metacarpal bone.

In the cases where a lack of transferrable muscle-tendon units is pronounced, this technique can be considered as a good treatment option.