gms | German Medical Science

Objectives/Interrogation: The problems of flexor tendons reconstruction in patients who present for surgery at many years after laceration are not often discussed in the literature. We would like to share our surgical treatment experience for the very long lasting flexor tendon injuries within the fingers.

Methods: Forty one patient with deep or both flexor tendons laceration in 49 fingers presented for tendon reconstruction at 2 to 30 years after injury and were treated by the same hand surgeon. In 20 cases surgery was performed at the time from 2 to 5 years after laceration, in 11 cases - at the time from 5 to 10 years and in 18 cases surgery was performed at the time from 10 to 30 years after injury.

In each of these patients two-staged reconstruction using passive silicone implants was carried out. Pulley system was carefully preserved, A2 pulley was cut transversely into several parts for to dilate each part separately. Stage 2 procedure - silicone rod removal and grafting from toe extensors - was usually performed at 12 months after rod implantation. Early active motion rehabilitation program in all patients was the same.

Results and Conclusions: The functional outcomes were clinically evaluated at follow-up examination 6 months after grafting in 31 patients to whom deep flexor tendons had been reconstructed in 36 fingers. Eight patients are still having ongoing treatment. Four patients were lost to final follow up, but their midterm results had been favorable. One patient declined stage 2 surgery. The overall outcome was excellent in 17 (47,2%) of fingers, good in 14 (38,9%) and fair in 3 (8,3%) of fingers. Excellent/good results ratio was 1,21. In 1 digit (2,8%) finger flexion contracture was evaluated and in 1 finger (2,8%) graft ruptured. These results are comparable to our general results of two-stage deep flexor tendon reconstruction in 316 cases: 52,9% of excellent results, 25,3% of good, contracture rate at 4% and rupture rate at 10,7%, with excellent/good results ratio at 2,1. Therefore the rate of excellent outcomes seems to be somewhat lower in long-standing lacerations group, but this difference is not statistically significant (t=0,6; P > 0,05).

In this very flexor tendons series the average time from injury was about 10 years. In spite of so long delay of reconstruction two-stage deep flexor tendon grafting provided good enough outcomes with rather low contracture rate. Hence FDP reconstruction should be attempted no matter how late after injury patient presents for surgery.