Extensor Indicis Proprius Opponensplasty – The Burkhalter Revisited

Abstract

The Extensor Indicis Proprius Opponensplasty although not widely exercised by hand surgeons has previously been shown to produce good results in the restoration of thumb opposition. Over the last 5 years the Extensor Indicis Proprius was selectively used in cases where the Flexor Digitorum Superficialis was unavailable or inappropriate. In a small case series operating on a total of six male patients with an average age of 32 and follow up of 12 months we have been impressed by the functional outcome and lack of donor site morbidity. The Extensor Indicis Proprius is expendable with minimal donor site morbidity, is of sufficient length and has an optimal line of pull to provide a superior mechanical advantage and a favourable torque when compared to Flexor Digitorum Superficialis.

Simultaneous Opponensplasty and Free Gracilis Muscle Flap for Thenar Reconstruction after Arteriovenous Malformation Resection

“…3 Although it has not been the most popular option, this technique has proved good functional outcomes with minimal donor site morbidity and better line of action when compared with other tendon transfers as FDS. 4 In our case, Burkhalter's opponensplasty was performed with the aim of recovering partial function, while the gracilis flap earned function and strength. However, after 3 months, gracilis muscle function was already visible and both opposition and adduction were more precise.…”

Upper Extremity Tendon Transfers: A Brief Review of History, Common Applications, and Technical Tips

“…In high median nerve injuries, in performing an opponensplasty, the EIP or the abductor digiti minimi, EDQ, ECU, or ECRL may be used. 43,44 In addition, in high median nerve injuries, the FDP function to the index and long fingers can be restored by transferring the BR, ECRL, or ECU to the FDP of the index and long fingers. Alternatively, the FDP to the index and long fingers may be sewn to the FDP of the ring and small fingers to create a "mass effect" digital flexion.…”

The rare injury of a closed digital extensor tendon avulsion of the third finger at its musculotendinous junction: Case presentation and brief overview of literature with regard to general, specific and practicable aspects to extensor tendon surgery involving tendon transfer procedures

“…To first: detachment of the EIP tendon leads to an extension lag in MCPJ II ranging from 0 to 25° and decreased extension strength ranging from 35 to 50% compared to the opposite index, but it is almost always well tolerated by the patients performing their activities of daily living at averaged follow-up's ranging from 12 months up to 15 years [91,92,94,98,100]. To second: reliable data could only found by the authors in 2 studies for the EIP tendon transfer to the EPL tendon.…”