Zone II digital deep flexion tendon transplantation

Suitable for left ring finger stale injury, superficial and deep flexor tendon defect, area II. Area II refers to the precautions for deep flexion allogeneic tendon transplantation: Note the following: 1. The sterility principle must be strictly observed during the operation to prevent infection; although mild infection, it can also cause adhesions around the tendon and make the operation fail. 2. Intraoperative operation must be careful and lightweight to reduce injuries. Keep the smooth surface of the tendon and the mesentery as much as possible. Do not pinch, press, or rub, and often protect it with wet gauze to prevent it from drying. This will prevent or reduce adhesion to surrounding tissue. Nerve and vascular supply to the muscle can not be damaged. Generally, the nerves and vascular branches enter in the upper half of the muscle. Therefore, when separating the muscle abdomen, try not to exceed the midpoint of the muscle abdomen. 3. The transferred tendon must be taken in a straight direction in order to be pulled straight and exert its maximum effectiveness. Therefore, the abdomen of the muscle should be separated as far as possible so that the tendon can reach a new dead center through a straight tunnel. For example, during quadricepsplasty surgery, if the hamstring muscles are not separated upward in the abdomen, the direction of pulling the sacrum will be more backward than upward after the transfer, and the effectiveness of muscle contraction will be affected. 4. The tunnel through which the transfer tendon passes must slide unimpeded. In order to meet this requirement, in addition to the straight path of the tendon, it is necessary to pay attention to the spaciousness of the tunnel. If it is obstructed by the edges of the bones or fascia, it should be removed. Generally, the tendon sheath replaced by the tendon is used as a tunnel, or another tunnel is used in the subcutaneous fat layer. The former is better than the latter, but the latter can freely adjust its straight direction, is more flexible, and is more commonly used clinically. 5. The transfer tendon must have a firm new stopping point in order to fully exert the stretch effect of the transfer muscle. There are two commonly used clinical fixation methods: Patellar tendon-to-tendon fixation method: Transfer and suture the adjacent normal tendon to the paralyzed tendon to replace the function of the paralyzed muscle; , Which also takes care of the function [Figure 1]. Its advantage is that the stopping point of the paralyzed tendon does not need to be changed, and the length of the tendon is guaranteed; but its disadvantage is that the paralyzed tendon is malleable, which may affect the muscle contraction performance over time. Therefore, it is only used clinically for upper limbs, fingers, toes and other parts. Children's paralyzed tendons do not develop well, and this method should not be used. Tendon-to-tendon fixation is usually performed with perforation suture [Fig. 2]. Patellar tendon-to-bone fixation: This fixation method is more reliable, with direct muscle strength, and the stopping point can be arbitrarily selected according to different situations. It is widely used in clinical practice and is especially suitable for lower limbs. There are many fixation methods, which can be fixed under the periosteum; or the tendon can be fixed on the rough cortex bone; or the tendon can be sutured through the intraosseous tunnel, or a groove can be cut on the bone to fix the tendon in the slot; Or use stainless steel wire to pull out the suture method to sew the tendon, that is, use stainless steel wire 8 to sew the tendon end (with a steel wire drawn at its proximal end), pass through the tendon end, and then pass through the bone hole for external skin fixation [Figure 3] . 6. The transferred tendon must maintain a certain tension in order to give full play to the effectiveness of muscle contraction. Tendon too loose will inevitably result in ineffective labor and can not fully play its role; on the contrary, excessive tendon tension will easily cause the suture to crack, and the muscle will be weak under the lasting tension. Therefore, when fixing the tendon, the joint should be held in a functional position first, and then the tendon is gently tensioned and sutured. 7. The transferred tendon is best to have similar functions to the paralyzed tendon, which is easier during muscle training; the opposite function of tendon transfer, which often has uncoordinated movements during training, requires patient exercise. 8. The tensile force of the transferred tendon should be equal to the original tensile force of the paralyzed muscle in order to be competent for its new task. If the strength is insufficient, other tendon transfers should be added; or bone auxiliary surgery, such as lengthening the power arm to enhance the contraction efficiency of the transfer muscles, or limit the range of motion of the joints to reduce muscle burden.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.