Skip to main content
SpringerLink
Log in

Options for Failed Flexor Tendon Surgery

  • Chapter
  • First Online:
Reoperative Hand Surgery

Abstract

Reconstructive flexor tendon surgery can be extremely difficult. The zone of failure will determine the potential reconstructive options that are available. For the thumb, tendon grafts as well as potential flexor digitorum superficialis tendon transfer are options for reconstruction. In the digits fusion as well as 2-stage tendon reconstructions are options. If the flexor tendon sheath is still intact, a single-stage tendon graft can sometimes be successful. These surgeries can be fraught with complications including failure of the graft to heal, rupture of the graft, scarring of the graft, and hand stiffness. These types of surgeries really should be performed by someone who performs hand surgery on a regular basis or who has specialized training in hand surgery. Both skill and creative thinking are required to succeed in these reconstructions. However, even in the best of hands, these cases may not turn out as the patient and surgeon had hoped. This chapter discusses the options available for reconstructing the finger or thumb that has failed initial repair.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Khaleghian R, Tonkin LJ, De Geus JJ, Lee JP. Ultrasonic examination of the flexor tendons of the fingers. J Clin Ultrasound. 1984;12(9):547–51.

    Article  PubMed  CAS  Google Scholar 

  2. Lee DH, Robbin ML, Galliott R, Graveman VA. Ultrasound evaluation of flexor tendon lacerations. J Hand Surg [Am]. 2000;25(2):236–41.

    Article  CAS  Google Scholar 

  3. Drape JL, Tardif-Chastenet de Gery S, Silbermann-Hoffman O, Chevrot A, Houvet P, Alnot JY, Benacerraf R. Closed ruptures of the flexor digitorum tendons: MRI evaluation. Skeletal Radiol. 1998;27(11):617–24.

    Google Scholar 

  4. Kumar BA, Tolat AR, Threepuraneni G, Jones B. The role of magnetic resonance imaging in late presentation of isolated injuries of the flexor digitorum profundus tendon in the finger. J Hand Surg [Br]. 2000;25(1):95–7.

    Article  CAS  Google Scholar 

  5. Matloub HS, Dzwierzynski WW, Erickson S, Sanger JR, Yousif NJ, Muoneke V. Magnetic resonance imaging scanning in the diagnosis of zone II flexor tendon rupture. J Hand Surg [Am]. 1996;21(3):451–5.

    Article  CAS  Google Scholar 

  6. Sourmelis SG, McGrouther DA. Retrieval of the retracted flexor tendon. J Hand Surg [Br]. 1987;12(1):109–11.

    Article  CAS  Google Scholar 

  7. Malerich MM, Baird RA, McMaster W, Erickson JM. Permissible limits of flexor digitorum profundus tendon advancement–an anatomic study. J Hand Surg [Am]. 1987;12(1):30–3.

    CAS  Google Scholar 

  8. Verdan C. Syndrome of the Quadriga. Surg Clin North Am. 1960;40:425–6.

    PubMed  CAS  Google Scholar 

  9. Boyer MI, Gelberman RH, Burns ME, Dinopoulos H, Hofem R, Silva MJ. Intrasynovial flexor tendon repair. An experimental study comparing low and high levels of in vivo force during rehabilitation in canines. J Bone Joint Surg Am. 2001;83-A(6):891–9.

    PubMed  CAS  Google Scholar 

  10. Lieber RL, Amiel D, Kaufman KR, Whitney J, Gelberman RH. Relationship between joint motion and flexor tendon force in the canine forelimb. J Hand Surg [Am]. 1996;21(6):957–62.

    Article  CAS  Google Scholar 

  11. Lieber RL, Silva MJ, Amiel D, Gelberman RH. Wrist and digital joint motion produce unique flexor tendon force and excursion in the canine forelimb. J Biomech. 1999;32(2):175–81.

    Article  PubMed  CAS  Google Scholar 

  12. Honner R. The late management of the isolated lesion of the flexor digitorum profundus tendon. Hand. 1975;7(2):171–4.

    Article  PubMed  CAS  Google Scholar 

  13. Nichols HM. The dilemma of the intact superficialis tendon. Hand. 1975;7(1):85–6.

    Article  PubMed  CAS  Google Scholar 

  14. Robertson DC. The place of flexor tendon grafts in the repair of flexor tendon injuries to the hand. Clin Orthop. 1959;15:16–21.

    PubMed  CAS  Google Scholar 

  15. Wilson RL. Flexor tendon grafting. Hand Clin. 1985;1(1):97–107.

    PubMed  CAS  Google Scholar 

  16. Wehbe MA. Tendon graft donor sites. J Hand Surg [Am]. 1992;17(6):1130–2.

    Article  CAS  Google Scholar 

  17. Morrison WA, Schlicht SM. The plantaris tendon as a tendo-osseous graft. Part II. Clinical studies. J Hand Surg [Br]. 1992;17(4):471–5.

    Article  CAS  Google Scholar 

  18. Tolat AR, Stanley JK. The extended palmaris longus tendon graft. J Hand Surg [Br]. 1993;18(2):239–40.

    Article  CAS  Google Scholar 

  19. Thompson NW, Mockford BJ, Cran GW. Absence of the palmaris longus muscle: a population study. Ulster Med J. 2001;70(1):22–4.

    PubMed  CAS  Google Scholar 

  20. Vastamaki M. Median nerve as free tendon graft. J Hand Surg [Br]. 1987;12(2):187–8.

    Article  CAS  Google Scholar 

  21. Weber RV, Mackinnon SE. Median nerve mistaken for palmaris longus tendon: restoration of function with sensory nerve transfers. Hand. 2007;2(1):1–4.

    Article  PubMed  Google Scholar 

  22. Parkes A. The “lumbrical plus” finger. J Bone Joint Surg Br. 1971;53(2):236–9.

    PubMed  CAS  Google Scholar 

  23. Pulvertaft RG. Tendon grafts for flexor tendon injuries in the fingers and thumb; a study of technique and results. J Bone Joint Surg Br. 1956;38-B(1):175–94.

    PubMed  CAS  Google Scholar 

  24. Watson AB. Some remarks on the repair of flexor tendons in the hand, with particular reference to the technique of free grafting. Br J Surg. 1955;43(177):35–42.

    Article  PubMed  CAS  Google Scholar 

  25. Boyer MI, Strickland JW, Engles D, Sachar K, Leversedge FJ. Flexor tendon repair and rehabilitation: state of the art in 2002. Instr Course Lect. 2003;52:137–61.

    PubMed  Google Scholar 

  26. Paneva-Holevich E. Two-stage tenoplasty in injury of the flexor tendons of the hand. J Bone Joint Surg Am. 1969;51(1):21–32.

    PubMed  CAS  Google Scholar 

  27. Barrie KA, Tomak SL, Cholewicki J, Wolfe SW. The role of multiple strands and locking sutures on gap formation of flexor tendon repairs during cyclical loading. J Hand Surg [Am]. 2000;25(4):714–20.

    Article  CAS  Google Scholar 

  28. Urbaniak JR. Repair of the flexor pollicis longus. Hand Clin. 1985;1(1):69–76.

    PubMed  CAS  Google Scholar 

  29. Urbaniak JR, Goldner JL. Laceration of the flexor pollicis longus tendon: delayed repair by advancement, free graft or direct suture. A clinical and experimental study. J Bone Joint Surg Am. 1973;55(6):1123–48.

    PubMed  CAS  Google Scholar 

  30. Kilgore Jr ES, Newmeyer WL, Graham III WP, Brown LG. The dubiousness of grafting the dispensable flexor pollicis longus. Am J Surg. 1976;132(2):292–6.

    Article  PubMed  Google Scholar 

  31. Posner MA. Flexor superficialis tendon transfers to the thumb–an alternative to the free tendon graft for treatment of chronic injuries within the digital sheath. J Hand Surg [Am]. 1983;8(6):876–81.

    CAS  Google Scholar 

  32. Schneider LH, Wiltshire D. Restoration of flexor pollicis longus function by flexor digitorum superficialis transfer. J Hand Surg [Am]. 1983;8(1):98–101.

    CAS  Google Scholar 

Additional References

  • Coyle Jr MP, Leddy TP, Leddy JP. Staged flexor tendon reconstruction fingertip to palm. J Hand Surg [Am]. 2002;27(4):581–5.

    Article  Google Scholar 

  • Bora Jr FW. Profundus tendon grafting with unimpaired sublimus function in children. Clin Orthop Relat Res. 1970;71:118–23.

    Article  PubMed  Google Scholar 

  • Goldner JL, Coonrad RW. Tendon grafting of the flexor profundus in the presence of a completely or partially intact flexor sublimis. J Bone Joint Surg Am. 1969;51(3):527–32.

    PubMed  CAS  Google Scholar 

  • Jaffe S, Weckesser E. Profundus tendon grafting with the sublimis intact. An end-result study of thirty patients. J Bone Joint Surg Am. 1967;49(7):1298–308.

    PubMed  CAS  Google Scholar 

  • McClinton MA, Curtis RM, Wilgis EF. One hundred tendon grafts for isolated flexor digitorum profundus injuries. J Hand Surg [Am]. 1982;7(3):224–9.

    CAS  Google Scholar 

  • Schneider LH, Wehbe MA. Delayed repair of flexor profundus tendon in the palm (zone 3) with superficialis transfer. J Hand Surg [Am]. 1988;13(2):227–30.

    Article  CAS  Google Scholar 

  • Sakellarides HT, Papadopoulos G. Surgical treatment of the divided flexor digitorum profundus tendon in zone 2, delayed more than 6 weeks, by tendon grafting in 50 cases. J Hand Surg [Br]. 1996;21(1):63–6.

    Article  CAS  Google Scholar 

  • Pulvertaft RG. The treatment of profundus division by the free tendon graft. J Bone Joint Surg Am. 1960;42(1):1363–71.

    Google Scholar 

  • Ipsen T, Barfred T. Early mobilization after flexor tendon grafting for isolated profundus tendon lesions. Scand J Plast Reconstr Surg Hand Surg. 1988;22(2):163–7.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hackensack University Medical Center, Hackensack, NJ, USA

    A. Ylenia Giuffrida MD

  2. Hospital for Special Surgery, Weill Medical College of Cornell University, 523 E. 72nd Street, 4th Floor Hand Center, New York, NY, 06830, USA

    Scott Wolfe MD

Authors
  1. A. Ylenia Giuffrida MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Scott Wolfe MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Scott Wolfe MD .

Editor information

Editors and Affiliations

  1. , Chairman, Department of Orthopedic, Ochsner Health System, New Orleans, 70121, Louisiana, USA

    Scott F.M. Duncan

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Giuffrida, A.Y., Wolfe, S. (2012). Options for Failed Flexor Tendon Surgery. In: Duncan, S. (eds) Reoperative Hand Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-2373-7_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-2373-7_3

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-2372-0

  • Online ISBN: 978-1-4614-2373-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation