الفهرس 
Flexor Tendon AnatomyOnly 14 pages are availabe for public view
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Abstract
Regaining satisfactory digital function after flexor tendon repair within the digit remains to be a difficult problem in hand surgery.
Primary repair of the injured flexor tendons remains the gold standard for regaining satisfactory digital function. However, in spite of careful primary treatment, the tendon and its gliding bed may be damaged so that a healing complex of scar develops and function is lost. In such severe injuries, tendon reconstruction is indicated and this can be done as one stage or multiple stages procedure. The goal here is to replace the tendon.
Staged flexor tendon reconstruction is considered as an alternative method to salvage useful finger function in badly scarred bed in spite of its drawbacks which are: lengthy operative time, more than one operation, two suture lines and the tendon system is simplified.
In two staged tendon reconstruction a new smooth flexor sheath and a fibrous capsule is expected to form in three to six months. During this period passive motion exercises continue to prevent joint stiffness, until a long tendon graft replaces the rod.
In the second stage ,the proximal repair of the tendon graft can be done either in the palm (pulp to palm) or in the wrist (pulp to wrist).
The advantages of pulp to palm tendon graft are; the need for a shorter graft and preservation of normal lumbrical function which may help in maintaining the normal cascade of finger flexion. Disadvantages include difficult tension adjustment and if a long graft is used it may lead to lumbrical plus deformity.
On the other hand, the advantages of pulp to wrist are; proper tension adjustment, and if proximal repair is performed in an injured tissue, secondary scarring may be less critical than in the palm, and the potential for motion limiting adhesions is minimized. Also, distal repair can be secured first followed by the proximal repair using Pulvertaft technique as a secure repair, minimizes the risk of rupture with early mobilization. Its disadvantages are; scarifying lumbrical muscles and the need for longer graft, as plantaris tendon or slips from extensor digitorum longus, except for the thumb and little finger.
The study was conducted in forty patients who were divided into two groups. In the 1st group (20 patients), staged flexor tendon reconstruction using pulp to palm tendon graft was used. In the 2nd group (20 patients), staged flexor tendon reconstruction using pulp to distal forearm tendon graft was used.
Three methods were used for assessment of the outcome of the results although there’s still great controversy about the site of the proximal repair of the tendon graft, our study showed that there was no significant difference between the two groups as regards the TAM, pulp to palm distance, and power grip.
Conclusion:
Flexor tendon reconstruction is a useful technique for regaining satisfactory digital function in neglected or failed primary repair of flexor tendons. Patient’s compliance to occupational hand therapy is essential for good outcome.
Pulp to palm tendon grafts give good results with: no scarring in the palm, intact lumbricals, intact proximal end of FDP in the palm and recent injury.
Pulp to wrist tendon grafts are indicated in: scaring in the palm, scarred lumbricals, multiple digits and old injuries.
There is no significant difference between pulp to palm and pulp to wrist tendon grafts as regard TAM, pulp to palm distance and power grip.