Transfer Of Flexor Digitorum Superficialis Tendons Research Articles

Infiltration Technique for the Fourth FDS Opponensplasty Under WALANT

Background: Wide-awake Local Anesthesia No Tourniquet (WALANT) is a surgical technique that relies on anesthetic and hemostatic agents to provide conditions suitable for hand surgery without sedation and a tourniquet. The opponensplasty using the fourth flexor digitorum superficialis tendon transfer with the pisiform pulley is one of the most used in severe carpal tunnel syndrome patient who is unable to perform thumb opposition due to thenar muscle atrophy with the benefit of small incision, less soft tissue dissection, easy to perform, good esthetic result and has minor morbidity. Key advantages of the pisiform pulley provide balancing abduction and flexion strength of the thumb. To date, there is no report using the WALANT technique for the fourth flexor digitorum superficialis opponensplasty with pisiform pulley. Materials and Method: Between January 2019 and January 2022, 18 patients (4 males and 14 females) with severe carpal tunnel syndrome with thenar muscle atrophy underwent fourth flexor digitorum superficialis opponensplasty as day surgery under the WALANT technique. Operative data, visual analog scale (VAS) pain scores, and complications were recorded. All patients underwent the procedure without any complications. Results: The average age of the patients was 58.4 (43 to 62) year-old. The average operative time was 38.4 (17 to 47) minutes. The average VAS score during the anesthetic injection was 6.43 (4 to -8). The average VAS pain score during the operation was 2.1 (1 to 3). The mean intraoperative blood loss was 3 (2.6 to 6.2) mL. Conclusions: The WALANT technique is safe and can be used as alternative anesthesia for the fourth flexor digitorum superficialis opponensplasty with pisiform pulley. This technique overcomes the problem of judging the appropriate amount of transfer tension by observing awake patients actively. Levels of Evidence: Therapeutic study, level IV

Anti-Claw Procedure with Modified Dynamic Flexor Digitorum Superficialis Transfer for Ulnar Nerve Palsy: Our Experience.

The ulnar nerve palsy is a distressing injury, resulting in clawing of hand. The cause of clawing is due to paralysis of the interosseous muscles in the presence of functioning long extensor and long flexors of fingers. Various methods have been proposed to correct this deformity which include both static and dynamic procedures. In this study, we share our experience with flexor digitorum superficialis tendon transfer using Zancolli's modification for anti-claw correction. It was a retrospective case series study. A record of 53 patients was included in the study, during a period between June 2013 to July 2017 with ulnar nerve palsy. The procedure done was flexor digitorum superficialis tendon transfer as dynamic anti-claw procedure. The follow-up period was three months. The outcomes assessed were grip strength by using sphygmomanometer and active range of motion of fingers assessed by fingers tips touching the palm. Fifty-three patients were included out of them, there were fifty males and three females. The mean age was 28±10 years. All patients underwent flexor digitorum superficialis transfer for ulnar claw hand. A total of 84.9% patients have good grip strength and 83% showed good active range of motion. Flexor digitorum superficialis tendon transfer is found to be effective, reliable and reproducible technique in ulnar nerve palsy where patient need grip strength, good range of motion and acceptable hand function for daily routine work.

Dynamic Rather than Static Procedures in Correcting Claw Deformities Due to Ulnar Nerve Palsy.

The theoretic disadvantage of dynamic tendon transfers is the perception that they are "more complex" than static procedures. The latter may provide a simple solution to claw deformity in a subset of patients; however, they completely disregard the disability associated with loss of the intrinsic musculature. Dynamic procedures reconstruct in part the deficient intrinsic forces and are thus capable of correcting the deformity and some disabilities associated with ulnar nerve palsy. In our practice, we have consistently achieved reasonable correction of claw deformity and improvement in tendon synchrony and grip strength with a modified Stiles-Bunnell, flexor digitorum superficialis tendon transfer.

The Effect of Flexor Carpi Ulnaris Pulley Design on Tendon Gliding Resistance After Flexor Digitorum Superficialis Tendon Transfer for Opposition Transfer

The flexor digitorum superficialis (FDS) tendon transfer can be used to restore opposition of the thumb. Several pulley designs have been proposed for this transfer. Gliding resistance is considered to be an important factor influencing the efficiency of the pulley design. Our purpose was to compare the gliding resistance among 4 commonly used pulleys for the FDS oppositional transfer. Ten fresh-frozen cadaver specimens were studied. The ring FDS was used as the donor tendon. An oppositional transfer was created using 4 pulley configurations: FDS passed around the flexor carpi ulnaris (a-FCU), FDS passed through a 2.5-cm circumference distally based FCU loop (2.5-FCU), FDS passed through a 3.5-cm circumference distally based FCU loop (3.5-FCU), and FDS passed through a longitudinal split in the FCU tendon (s-FCU). The gliding resistance was measured with the thumb in radial abduction and maximum opposition. In abduction, the average FDS gliding resistance of a-FCU, 2.5-FCU, 3.5-FCU, and s-FCU was 0.66 N (SD, 0.14 N), 0.70 N (SD, 0.14 N), 0.68 N (SD, 0.16 N), and 0.79 N (SD, 0.15 N), respectively. The peak gliding resistance of a-FCU, 2.5-FCU, 3.5-FCU, and s-FCU was 0.75 N (SD, 0.16 N), 0.74 N (SD, 0.15 N), 0.74 N (SD, 0.15 N), and 0.86 N (SD, 0.15 N), respectively. The average gliding resistance of the s-FCU was found to be significantly higher than that of the a-FCU and 3.5-FCU pulleys. In opposition, there were no differences in average or peak gliding resistance among the different pulley designs. In this invitro cadaveric study, the FDS split pulley produced higher gliding resistance. Consideration of the pulley configuration may improve the overall thumb function by decreasing forces needed to overcome gliding resistance.

Wide-Awake Approach for Flexor Digitorum Superficialis Tendon Transfer Followed by Early Active Mobilization.

Background The standard clinical practice to treat closed ruptures of the flexor digitorum profundus (FDP) tendons includes free tendon grafting; however, it is not suitable when the muscle amplitude of the ruptured FDP is not sufficient. We report outcomes of six patients who underwent flexor digitorum superficialis (FDS) tendon transfer of the ring finger using the wide-awake approach to repair the closed rupture of the FDP tendon of the little finger in zone 3 or 4. Methods The patients were identified by reviewing our institutional billing records from January 2012 to October 2019 for the International Classification of Disease 10 code M66.3 that describes the diagnosis as “spontaneous rupture of flexor tendons.” Results The patients comprised two men and four women with an average age of 72.2 years (standard deviation [SD], 8.4 years). All patients were hospitalized after surgery to undergo early active mobilization. The average total active motion at the final evaluation was 201.8° (range: 85–248°). According to Strickland’s criteria, outcomes were excellent for two, good for three, and poor for one patient. No patients complained about the ring finger. Conclusion These results suggest that FDS tendon transfer is recommended when the muscle amplitude of the ruptured FDP is insufficient. We believe that the wide-awake approach and early active mobilization may contribute to satisfactory outcomes.

Correction of ulnar claw hand and Wartenberg’s sign

Ulnar claw hand usually occurs when the ulnar nerve is damaged distally. Claw hand deformity is characterized by metacarpophalangeal hyperextension and interphalangeal flexion, making it impossible to oppose the fingers and thumb. Bouvier’s test is used to guide the procedure. Palliative surgery requires prior preparation of paralytic hands. In case of a positive Bouvier’s test, Zancolli’s lasso technique is preferred because of its effectiveness. Capsuloplasty with anteroposterior transosseous fixation is used if the bone is strong enough and when flexor digitorum profondus muscle is inactive and does not allow flexor digitorum superficialis tendon transfer. In case of a negative Bouvier’s test with interphalangeal extension deficit of 45° of less, direct interossei muscle restoration techniques by active transfers are performed. If the interphalangeal extension deficit is more than 45°, proximal interphalangeal arthrodesis is indicated.Wartenberg first described actively irreducible abduction of the little finger. Wartenberg’s sign is seen when ulnar paralysis occurs, and during ulnar nerve regeneration. Treatment of isolated Wartenberg's sign consists of re-routing the extensor digiti minimi. Among the other techniques, Belmahi’s “tie lasso” is preferred when flexible claw hand is associated with Wartenberg’s sign.

RETRACTED: Flexor Digitorum Superficialis tendon transfer for a long-standing boutonniere deformity finger- a retrospective study of 11 cases

A long-standing boutonniere deformity is challenging to treat because of well-established complex pathophysiological changes in the extensor expansion mechanism. The role of ulnar slip flexor digitorum superficialis tendon transfer for central slip reconstruction in such chronic deformities is analyzed and correlated with the functional outcome. Ulnar slip FDS tendon corrects the long-standing boutonniere deformity and replicates anatomical repair. We conducted a retrospective study between 2014 and 2016 and operated on 11 patients by FDS tendon transfer to the extensor expansion's central slip. We compared the preoperative and postoperative range of movements in the proximal interphalangeal joint, distal interphalangeal joint, Visual analogue score, and grip strength. Also, we statistically correlated various parameters and non-parameters affecting the functional outcomes. The mean time interval between the injury and surgery was 39 months. The average follow-up of our study was 15.4 months. Ten of the 11 patients had good functional outcomes with statistically significant improvement in the movements and grip strength (p<0.05). Ulnar slip FDS tendon transfer is effective for central slip reconstruction in a long-standing boutonniere deformity. Minimal degrees of proximal interphalangeal joint extension deficit is inevitable due to the chronicity and adaptive changes in the ligament-tendon-bone complex. IV; retrospective case study.

Evaluation of Results after Flexor Digitorum Superficialis Tendon Transfer to Provide Fingers and Thumb Extension in Radial Nerve Lesions

Purpose: Objective and subjective evaluation of the resultsof flexor digitorum superficialis tendon transfer for the restorationof finger extension in irreparable radial nerve lesions.Methods: Restoration of finger extension, thumb extension,was done in 10 patients (seven with radial nerve and threewith posterior interossius nerve injury; age range: 5-60 years).We used tendon transfer technique using the flexor digitorumsuperficialis (FDS) 3 [to extensor pollicis longus (EPL)]and FDS 4 [to extensor digitorum communis (EDC)] as donorsfor the reconstruction of fingers and thumb extension (allpatients) and pronator teres (PT) for wrist extension.Results: Eight patients (out of 10) yielded 'Excellent togood' results: These patients showed marked improvement tothe motor power scoring M4-M5 on the MRC grading systemwhile 2 patients (out of 10) yielded 'Fair' results: Moderateimprovement to the motor power scoring M3 on the MRCgrading system.Conclusions: The FDS transfer provides thumb extensionindependent from the fingers and wrist extension, becausethe FDS control for each finger is independent from the otherfingers

Outcome of flexor digitorum superficialis opponensplasty for Type II and IIIA thumb hypoplasia.

This study reports on outcomes of the flexor digitorum superficialis tendon transfer from the ring finger in Type II and IIIA hypoplastic thumbs. We included 22 patients with 27 involved hands: 16 Type II thumbs and five Type IIIA treated by transfer and six non-operated Type II thumbs. The outcomes were assessed by range of motion, strength, sensibility, joint stability and patient/parent satisfaction. Compared with normative data, the range of motion was diminished in all patient groups. Opposition strength in operated Type II thumbs was significantly better than in non-operated thumbs. Grip strength, pinch strength, tripod strength and key pinch strength were approximately 50% of normal in Type II thumbs and 35% in Type IIIA thumbs. Metacarpophalangeal joint stability was restored in all operated Type II thumbs and in 40% of Type IIIA thumbs. We conclude that the flexor digitorum superficialis tendon transfer of the ring finger is a good functioning opponensplasty in both Type II and IIIA thumbs. The transfer provides excellent stability of the metacarpophalangeal joint in Type II thumbs. Level IV.

Repair of old zone II and zone III flexor pollicis longus tendon injury

目的 探讨重建Ⅱ、Ⅲ区陈旧性拇长屈肌腱损伤的手术疗效.方法对20例Ⅱ、Ⅲ区陈旧性拇长屈肌腱损伤的患者,根据手术方式分成两组: A组10例,采用环指指浅屈肌腱移位修复拇长屈肌腱;B组10例,采用掌长肌腱移植修复.结果术后随访10～18个月,平均12个月.按照屈肌腱术后评定标准(Kleinert)评定[1],A组优良率为90%,B组优良率30%.A组明显优于B组.结论对伤后时间超过8周的Ⅱ、Ⅲ区拇长屈肌腱损伤首选修复方法是行环指指浅屈肌腱移位术。

Rupture of the flexor pollicis longus tendon after 30 years due to migration of a retained foreign body

Delayed rupture of a flexor tendon in the hand due to the presence of a retained foreign body is rare. We present the case of a late flexor pollicis longus rupture 30 years after traumatic implantation of a glass fragment. The foreign body had migrated distally a distance of 4.5 cm from the site of the original injury and eroded into the flexor tendon sheath. Thumb function was restored with a flexor digitorum superficialis tendon transfer from the ring finger with excellent results.

Flexor digitorum superficialis tendon transfer for intrinsic replacement. Long-term results and the effect on donor fingers.

This study is a review of 127 hands in 100 patients in whom one or two FDS tendons were used to correct claw-hand deformity and/or loss of opposition of the thumb. In lumbrical replacement the results were graded as excellent in 16 hands (21%) and good in 43 hands (57%). For opponensplasty the results were excellent in 26 hands (32%) and good in 42 hands (51%). Possible defects that can develop in the donor finger are: swan-neck deformity, flexion posture of the DIP joint, not as part of the swan-neck deformity, check-rein deformity or flexion contracture, and insufficient finger flexion. Of the 158 fingers swan-neck deformity was seen in 15%, DIP flexion in 29%, check-rein deformity in 26% and insufficient finger flexion in 18%. The latter occurred with another defect. In 48 fingers (30%) no defects were observed.

Late flexor pollicis longus tendon rupture due to retained glass fragments

A retained glass fragment caused a flexor pollicis longus tendon rupture 23 years after the patient's initial injury. A review of the literature shows that although previous cases of delayed damage from retained objects have been reported, this is the first report of a tendon injury that was preceded by such a long asymptomatic period. The lesion was treated with a flexor digitorum superficialis tendon transfer from the ring finger with excellent functional results.