Redirection of the extensor pollicis longus tendon

The long extensor tendon of the thumb is used for the surgical treatment of the palm palm malformation. The palm of the thumb is malformed, also known as the thumb adductor deformity, or the claw-shaped thumb deformity. This malformation prevents the item from entering the palm of the hand and prevents the thumb from assisting other fingers in grasping the item. The reason for the deformity of the palm of the thumb is that the flexor hallucis longus, the flexor hallucis longus muscle, the abductor muscle and the dorsal muscle of the first interosseous muscle are in a paralyzed state, and the muscles of the extensor hallucis longus, the extensor pollicis longus and the adductor muscle of the thumb are weak. The extensor of the longus extensor muscle also plays a role in the formation of the adductive deformity of the thumb during the relaxation period. In 1981, House, Gwathney, and Fidler classified it into 4 types based on the clinical manifestations of thumb palm malformation. Type I: Only the metacarpal contracture is the most common type. Type II: Condensation of the metacarpal metacarpal and metacarpophalangeal joint flexion deformity. Type III: The metacarpal contraction of the metacarpal and the metacarpophalangeal joint deformity or instability, which is the second most common malformation. Type IV: contraction of the metacarpal iliac crest and metacarpophalangeal joint and interphalangeal joint flexion deformity, which is considered to be the most severe deformity, caused by the flexor hallucis longus and the intrinsic tendon of the thumb. Treating diseases: and referring to deformities Indication The long extensor tendon of the thumb is suitable for the thumb and extensor tendon dysfunction. Preoperative preparation Regular preoperative examination. Surgical procedure 1. Make an incision along the edge of the fish line at the palm, loosening the deep body of the thumb and the short flexor of the thumb. A longitudinal incision on the dorsal side of the thumb releases the origin of the first interosseous muscle from the first metacarpal. The incision on the dorsal side of the thumb is then extended distally to the proximal phalanx to reveal the extensor tendon cap. The long extensor muscle of the thumb was found at the metacarpophalangeal joint, and the tendon was cut from the extensor tendon cap 10 mm distal to the joint. This leaves a 4mm wide longitudinal defect on the skull cap. Be careful to keep enough aponeurosis edges to close the incision. 2. Find the flexor hallucis longus by a distal incision of the humerus and bring it to the forearm. The posterior extensor muscle space was used as the trochlear to maintain the position of the long extensor tendon of the thumb. The curved vascular clamp or tendon guide was used to extend from the dorsal thumb of the thumb along the short extensor tendon of the thumb to the first extensor muscle for the extension of the thumb. The muscles are redirected along the wrist. 3. Use the vascular clamp to grasp the extensor tendon of the thumb and pass through the gap of the first extensor muscle and withdraw it to the distal incision. If it is difficult to redirect the tendon through this gap, the buckling extensor muscle and the thumb longissimus muscle can be bypassed in the proximal side of the gap and then into the incision on the dorsal side of the thumb. 4. The long extensor tendon of the thumb is passed through a transverse tunnel made on the dorsal side of the metacarpophalangeal joint capsule, and sutured under sufficient tension to advance the original position by 1 to 2 cm. If the metacarpophalangeal joint can be overstretched, this tunnel should be located proximal to the articular surface to prevent further overstretching. In this case, a Kirschner wire should be temporarily fixed through the slightly flexed metacarpophalangeal joint. The distal end of the long extensor tendon of the thumb is sutured to the tendon of the extensor tendon to close the original longitudinal defect and prevent flexion deformity of the interphalangeal joint. Close the incision in the usual way.

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