Open Access
CC BY 4.0 · Arch Plast Surg 2024; 51(01): 118-125
DOI: 10.1055/a-2190-8487
Hand/Peripheral Nerve
Case Report

Staged Tendon Repair to Improve Range of Motion in Tamai Zone 4 Replantation: Two Case Reports

Takeo Matsusue 
1   Department of Plastic Reconstructive Surgery, Kansai Electric Power Hospital, Osaka, Japan
› Author Affiliations
› Further Information
  Permissions and Reprints
Preview

Abstract

Tamai zone 4 replantation, defined as the replantation at a level proximal to the flexor digitorum superficialis' insertion and distal to where the common digital artery branches into the proper digital artery, has poor functional results because making orthosis and rehabilitation protocols that protect the bone and the flexor and extensor tendons simultaneously difficult. Two cases of Tamai zone 4 replantation are presented: one case of an index finger replantation at the proximal phalanx and a case of ring finger replantation at the proximal interphalangeal joint. The author did not repair the flexor tendon intentionally in the primary replantation and performed two-stage flexor tendon reconstruction later. The total active motions (TAMs) at the last follow-up were 215 and 180 degrees, respectively, with the latter distal interphalangeal joint being an arthrodesis. Both cases had no extension lag in the proximal interphalangeal joint. These results were much better than those in previous reports, in which the mean TAM was 133 degrees or less. The good results appeared to be mainly due to the reasonable and clear postoperative rehabilitation protocols made by the proposed procedure. This procedure may be useful for obtaining reproducible functional results even in Tamai zone 4 replantation.

Keywords

replantation - range of motion - articular - rehabilitation - tendon - finger

Author's Contribution

T.M. is the sole contributor of this article.


Ethical Approval

The study was approved by the Institutional Review Board of Kansai Electric Power Hospital (IRB no. 22-033). These treatments were performed in accordance with the principles of the Declaration of Helsinki.


Patient Consent

The patients provided written informed consent for the publication and the use of their images.




Publication History

Received: 28 July 2022

Accepted: 07 October 2023

Accepted Manuscript online:
12 October 2023

Article published online:
28 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA