Intrasynovial Tendon Graft for Chronic Flexor Tendon Laceration of the Finger: A Case Report

Jun Sasaki,Masanori Hayashi,Hiroyuki Kato,Toshiro Itsubo,Shigeharu Uchiyama,Koichi Nakamura

doi:10.2174/1874325001307010282

Abstract

We present the case of a patient with flexor digitorum profundus tendon laceration at the A2 pulley level caused by an injury to the base of the right ring finger by a knife. The patient was treated by flexor tendon reconstruction from the palm to the fingertip by using the left second toe flexor tendon as a graft, which improved the active range of motion. Further improvement was achieved by subsequent tenolysis, which eventually restored nearly normal function. Our experience with this case indicates that the intrasynovial tendon is a reasonable graft source for the synovial space in fingers and may enable restoration of excellent postoperative function.

Highlights

Flexor tendon grafting in patients with chronic flexor tendon injury in the finger does not always provide satisfactory outcomes [1,2,3,4]
An in vivo animal study in dogs showed that an intrasynovial tendon graft within the digital sheath was histologically viable and normal, and that no adhesion occurred between the grafted tendon and the digital sheath at the so-called no man’s land [14]
Use of canine models clearly demonstrated that compared to extrasynovial tendon grafts, intrasynovial tendon grafts are associated with less tenocyte death and less adhesion around the tendon

Summary

Introduction

Flexor tendon grafting in patients with chronic flexor tendon injury in the finger does not always provide satisfactory outcomes [1,2,3,4]. The palmaris longus tendon and the plantaris tendon, both of which are extrasynovial tendons, are the most popular graft sources used for flexor tendon reconstruction because they are easy to harvest without donor site morbidity. Leversedge et al first reported the outcomes in 8 cases of flexor tendon injuries, wherein the second toe flexor tendon was utilized as the intrasynovial graft [13]; according to their study, the outcomes have been favorable, but not necessarily superior to those of the conventional procedure.

Results

Conclusion