Abstract
The use of two-staged flexor tendon grafting for the late reconstruction after severance of both flexor ten dons in zone II in the finger is well established. 1 If the procedure takes place a few months or more after the initial injury, most of the flexor tendon sheath is nar rowed and scarred, and in many instances it is impos sible to pass the silicone rod under the pulley system. If the rod is to be placed outside the confines of the flexor sheath, an adequate pulley system has to be recon structed to prevent later bow stringing of the grafted flexor tendon. The relative importance of the individual pulleys as has been studied by Doyle and Blythe 2 dem onstrates that at least two pulleys, A-2 and A-4, should be reconstructed or even more for optimal efficiency. Many techniques have been used to reconstruct the pulleys over the silicone rod. 3 , 4 Most use grafts taken either from the remnants of the flexor tendons, the pal maris tendon, or fascia lata. These have to be properly sutured or fixed to the fibroosseous floor of the sheath. The belt loop technique by use of the palmar plates of the joints produces a good local material in the right location to comply with the desired needs of pulley reconstruction. The surgical technique is to open the finger through a zig zag incision. The remnants of the severed tendons in zone II are excised. The palmar aspects of the palmar plates of the joints are exposed. The palmar plate is incised twice in each joint. Two
Published Version
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