A New Technique of Attachment of Flexor Tendons to The Distal Phalanx without A Button Tie-Over

Abstract

A new technique of attachment of the flexor digitorum profundus tendon and flexor tendon grafts to the distal phalanx, without using a button on the nail, is described and its use reported in 14 cases.

Treatment of unfavourable results of flexor tendon surgery: Ruptured repairs, tethered repairs and pulley incompetence

“…More commonly, we pass the sutures along the sides of the phalanx and through a hole in the tuft of the distal phalanx, to avoid the button (Sood and Elliot, 1996). [15] The tendon can be attached more proximally to the distal phalanx in a similar manner, or using a bone tag. The graft is sutured to the proximal part of either the FDP, or FDS, tendon (each has its advocates) with a Pulvertaft weave, either in the palm or at the wrist.…”

Staged tendon grafts and soft tissue coverage

“…Before working distally to attach the graft to the distal phalanx, it is advisable to pass a temporary suture through the proximal end of the graft and attach it to the tissues in the palmar or wrist incision to prevent the tendon graft being pulled out of the sheath repeatedly during the distal suturing activities. Numerous methods of attachment of the distal end of the graft to the distal phalanx have been described: we mostly use the technique we described in 1996 which dispenses with the use of a button on the nail of the digit[26] and is simple, effective and cheap. The proximal end of the graft is woven into the tendon of the motor using Pulvertaft's technique, with the tension of the new musculotendinous unit being set in the conventional manner by reference to the finger cascade when the hand is resting on the operating table with the wrist in the neutral position.…”

Die Beugesehnennaht nach Mantero - eine Alternative?

“…Gerade in der Zone 1 kann die Rekonstruktion einer Beugesehne aber technisch schwierig sein, da konventionelle Nahttechniken bei einem sehr kurzen Sehnenstumpf eventuell nur schwer durchführbar sind und die transossäre Refixation aufwändig ist [12,13]. Hart und Watson [9] befürchteten ein erhöhtes Infektrisiko aufgrund der transkutanen Ausleitung des Fadens, was sich bei den von uns nachuntersuchten Patienten nicht bestätigte, obwohl bei immerhin einem Fünftel unserer Patienten durch Kreissägenverletzungen oder Quetschverletzungen nicht unerhebliche begleitende Weichteilschäden vorlagen.…”