Résultats et complications des transferts fléchisseurs superficiels-fléchisseurs profonds chez le patient cérébrolésé : une série de 26 patients

Abstract

The hand of the spastic patient combines motor deficit, abnormal muscle tone causing spasticity, and sensory defect. The purpose of the surgical program could be functional by restoring grasp or nonfunctional by resolving hygienic problems and improving cosmetic appearance due to the clenched fist deformity. The superficialis-to-profundus tendon transfer, first described by Braun et al., allows the opening of nonfunctional hands. The aim of our study was to confirm the efficacy of this technique to correct vicious attitudes, to highlight a possible functional gain and finally to identify any complications. Patients (9 women and 17 men, aged 36–79 years) were evaluated by a team of rehabilitation physicians and orthopedic surgeons. Palliative transfer of the flexor digitorum superficialis tendons to the flexor digitorum profundus tendons has been achieved. Pictures were taken both preoperatively and during follow-up consultations. The hands were classified according to their appearance- the position of the wrist and fingers (Keenan et al.). Surgery complications were sought. Mean follow-up was 47 months. Preoperatively, all hands were classified type 5 (closed hand no distance between palm and pulp). Postoperatively, 38% of patients have type 1 hand (wrist in neutral position, metacarpophalangeal joints (MCP) and proximal interphalangeal (PIP) at 20° of flexion) and 46% type 2 hand (fingers are more flexed [MCP and PIP at 40° of flexion]), with good cosmetic appearance. None of them have hygienic problems. Mean House score increased from 0 to 0.9, with 7 patients improved. Four patients had an attitude of supination of the forearm, 10 had an intrinsic-plus deformity and 6 had swan neck deformity of the finger. Secondary procedures had to be made. This transfer gives satisfactory results on the opening of the hand but with significant complications. Intrinsic spasticity may be unmasked. Accessories pronator muscles release, while the biceps is spastic, can lead to an attitude of supination of the forearm, which causes functional and esthetic problems.