Sekundäre Beugesehnenrekonstruktion

Eine sekundäre Beugesehnenrekonstruktion kann indiziert sein, wenn eine Verletzung verspätet erkannt oder behandelt wird, längere Defektstrecken bestehen oder es zur Sehnen- bzw. Nahtruptur nach Primärnaht kommt. Je nach Beschaffenheit des Beugesehnengleitkanals kommen ein- und zweizeitige komplexe handchirurgische Verfahren zum Einsatz.

Abstract

Objective

Reconstruction of grip function after chronic flexor tendon injury.

Indication

Absence of active motion of the distal and proximal interphalangeal joints after chronic flexor tendon injuries, deliberately omitted or failed primary flexor tendon reconstruction.

Contraindication (for two-stage reconstruction with silicon spacer)

Absence of passive motion of the MCP, distal and proximal interphalangeal joints. Uncooperative patient or a patient that is not capable of cooperation. Acute local or systemic infections. Relative contraindication: reconstruction in little finger.

Surgical technique

Single-stage reconstruction is only possible when the sliding canal of the flexor tendon is preserved. For tendon interposition in case of intact motor function of the flexor, the ipsilateral palmaris longus tendon (mean length 13 cm) can be used as well as the plantaris tendon (mean length 31 cm) or several extensor digitorum longus tendons of the second, third and fourth toe (mean length 31 cm, can be optionally sutured together to gain more length). Tendon transposition, e.g. using the FDS 4, is also possible, especially for restoration of thumb flexion. A two-stage procedure aims to induce a neo sliding canal through implantation of a silicon spacer that is sutured to the distal FDP stump and passed through the carpal tunnel, ending in the distal forearm. After three months of intensive daily training the tendon transfer or interposition can be performed into the neo sliding canal. Proximally the original muscle or the muscle of a neighbor FDS can be chosen.

Conclusion

Secondary flexor tendon reconstruction is a complex surgical procedure requiring experience in hand surgery and a well-established postoperative hand therapeutic treatment regimen. Besides tendon transfers, two-staged tendon transplantation after silicon spacer implantation can be an option. Tenodeses and arthrodesis should always kept in mind as valuable salvage procedures.

Schlüsselwörter

Beugesehnenrekonstruktion - zweizeitige Operation - Silikonstab - Sehnentransfer - Sehnentransplantate

Keywords

flexor tendon reconstruction - two-stage-procedure - silicon spacer - tendon transfer - tendon grafts

Publication History

Article published online:
14 November 2023

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