16.7 Finger extensor aponeurosis reconstruction by dermical bandelets

Abstract

was assessed every 100 cycles. Samples were tested to failure at the completion of 500 cycles. Results were compared to previously published data using the same model for testing other repair techniques. Results: Mean gap formation after 500 cycles was 1.84 mm. Mean load to failure was 47.5 N. This compared favourably with data for other repair modalities. Clinical evaluation of patients following repair of distal FDP division confirmed comparable outcome to other repair modalities. Conclusion: Our results demonstrate that this repair technique is biomechanical sound and has comparable in vitro strength compared to other techniques of repair at this site. The repair can be used clinically with good results and is technically straightforward, having the advantage of not requiring suturing over a button, and not requiring suture anchor technology.Introduction: The lesions of the distal extensor aponeurosis (Mallet finger) due to various types of injuries represent an intruding and disabling disease of the fingers. This can lead, despite treatment, to joint modifications and movement impairment. Various methods of repair were recommended from splint immobilization for long periods to tendon reconstruction by different techniques. We describe possible new method consisting in reconstruction by dermical bandelets. Material and methods: Our technique is based on a long and narrow (2-3 cm/2-3 mm) de-epithelized skin bandelet harvested from one border of the longitudinal incision made to explore the lesion. This bandelet remains pedicled on its proximal end. It is reinserted distally at the base of the distal phalanx through a transosseous hole using a steel wire 4/0-5/0 and is also sutured to the remnants of the aponeurosis. The bandelet is then buried subcutaneous. The DIP joint is maintained in extension by a intramedullary K-wire. The DIP joint is also immobilized using a splint. The Kwire is removed after 3 weeks and the steel wire after 4 weeks. The splint is maintained one more week, followed by controlled mobilization. Results: We used this method in 97 cases. We had recurrence of the deformity in 10 cases, from which three cases required arthrodesis. The functional restoration is 75% to 90% in DIP stability and mobility, with an extension deficit of 5 to 10 degrees.