Two-stage flexor tendon reconstruction in zone II using a silicone rod and a pedicled intrasynovial graft

• Published in: The Journal of hand surgery (American ed.) Vol. 28; no. 4; pp. 652 - 660
• Main Authors: Beris, Alexandros E, Darlis, Nickolaos A, Korompilias, Anastasios V, Vekris, Marios D, Mitsionis, Gregory I, Soucacos, Panayiotis N
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2003; Elsevier Science Ltd
• Subjects: Adolescent; Adult; Child; Child, Preschool; Female; Fingers - pathology; Fingers - surgery; Flexor tendons; Follow-Up Studies; Humans; intrasynovial graft; Joint Capsule - pathology; Joint Capsule - surgery; Male; Middle Aged; Paneva-Holevich; Prostheses and Implants; Prosthesis Implantation - methods; Silicones; staged reconstruction; Tendon Injuries - pathology; Tendon Injuries - surgery; Treatment Outcome; staged reconstruction; intrasynovial graft; Flexor tendons; Paneva-Holevich
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/S0363-5023(03)00146-1

Purpose: To evaluate the results of a modified Paneva-Holevich technique for flexor tendon reconstruction in zone II.
Methods: Twenty patients (22 digits) with poor prognosis injuries (Boyes grade 2–5) were reconstructed. The technique included placing a silicone rod and creating a loop between the flexor digitorum profundus (FDP) and the flexor digitorum superficialis (FDS) in the first stage and reflecting the latter as a pedicled graft through the pseudosheath created around the silicone rod in the second stage.
Results: After a follow-up period of at least 1 year (mean, 50 mo) the rate of good and excellent results was 82% according to the Buck-Gramco scale and 73% using the modified Strickland scale.
Conclusions: These results compare favorably with those using the classic (Hunter) 2-stage reconstructions with a silicone rod and a free tendon graft. Apart from technical versatility, additional advantages of the technique include using a local intrasynovial graft, the absence of donor site morbidity, and a low rate of postreconstruction tendon ruptures and tenolysis.