Flexor pollicis longus repair in a patient with Linburg-Comstock anomaly: A case report

Abstract

Background: We present a patient with this anomaly who sustained a saw cut injury to his hand resulting in severance of the FPL and bilateral digital nerves of the thumb. Methods: A 36-year old male laborer who sustained a saw cut injury to his dominant right hand presented to the emergency department. The wound extended from the skin edge of the first web to the base of first metacarpal in the palm at Urbaniak zone 3. The FPL tendon and both digital nerves were cut. In the operating room, the wound was enlarged with Z incisions and a dissection deep into the wound was conducted. The cut end of the FPL tendon was found and secured using a different technique. Bilateral digital nerve repair was performed with interpositional grafting of the lateral antecubital cutaneous nerve bundles. Results: At the end of the rehabilitation program, the thumb recovered full range of motion, and physical examination revealed synchronous flexion movement (synkinesis) of the thumb and index finger. Conclusion: Flexor pollicis longus tendon lacerations are common in the clinical practice of hand surgeons. Making a separate proximal wrist incision is a very useful technique to reach a proximal tendon stump. Otherwise, aggressive maneuvers may cause additional damage to the tendons involved and result in unpredicted outcomes. The attempts to retrieve the tendon at the injury site resulted in failure and gave a tethering sensation to the surgeon who recalled the Linburg-Comstock anomaly.