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Flexor Tendon Reconstruction

Active Range of Motion After the First Stage of Silicone Rod Insertion

Al-Qattan, Mohammad M., MBBS

doi: 10.1097/SAP.0000000000001815
Hand Surgery

Purpose In the first stage of flexor tendon reconstruction, a silicon rod is fixed distally to the remnant of the flexor tendon at the distal phalanx. The proximal end of the rod is left free (unsutured) in the distal forearm. Hence, the rod insertion is not expected to result in any active flexion of the finger. The author reports on a case series in which adhesions have occurred between the rod and the adjacent flexor tendons in the distal forearm.

Methods A retrospective study of 110 patients who underwent 2-stage flexor tendon reconstruction by the author revealed 5 patients in which the fingers were actively moving good enough after the insertion of the silicone rod to the extent that patients refused to undergo the second grafting procedure. Complications, range of motion, strength, and patient satisfaction were documented.

Results There were no complications related to the surgery or the presence of the rod for several years. Using the Strickland criteria, all patients qualified for a good outcome. Grip strength of the affected hand averaged 85% of the contralateral normal hand, and the pinch strength of the affected finger against the thumb averaged 68% compared with the contralateral side. All patients/parents were satisfied. Ultrasound imaging confirmed the presence of adhesions between the proximal end of the silicone rod and the adjacent flexor tendons.

Conclusions Our series documents a very unusual “desirable” event following the first-stage flexor tendon reconstruction. The study also documents the lack of silicone rod–related complications on long-term follow-up. The results may also encourage the use of permanent implants in flexor tendon reconstruction.

From the Division of Plastic Surgery, King Saud University; and the Division of Plastic Surgery at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Received September 21, 2018, and accepted for publication, after revision November 26, 2018.

The study was approved by the research committee of Riyadh National Hospital (CARE).

Conflicts of interest and sources of funding: The work was supported by the College of Medicine Research Center, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia. The author declares no conflict of interest.

Reprints: Mohammad M. Al-Qattan, MBBS, PO Box 18097, Riyadh 11415, Saudi Arabia. E-mail:

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