Two-stage transplantation of digital flexor tendons. 43 patients reviewed after 3 to 15 years

We reviewed all 43 patients who had been operated during a 13 year period a median of 9 (range 3 to 15) years after the second stage operation. The initial injury had been sustained 5 (0 to 184) months before the first stage operation and had consisted of a sharp cut in 35 cases, saw injury in 3 and crushing in 3. Two had closed ruptures of the FDS in fingers with untreated old FDP ruptures. There had been no bony or extensor tendon injury of the fingers, but a digital nerve was cut in 20 cases. One finger was reconstructed in each patient. There were 10 thumbs, 4 index fingers, 2 third fingers, 6 ring fingers, and 21 little fingers. The interval between first and second stage operations was 19 (14 to 51) weeks. At review active motion was recorded and the patients indicated on a VAS scale their subjective evaluation of the finger (0= normal finger; 100= worst imaginable finger). 26 further procedures had been performed in 18 of the 43 fingers after the second stage operation. These included 7 re-sutures of the transplanted tendon (3 in the same finger), 5 tenolysis, 2 PIP joint capsulotomies, 3 DIP arthrodesis (2 combined with reinsertion of the tendon to the middle phalanx), 1 DIP + PIP arthrodesis, and 3 PIP amputations. One further finger will be amputated and 2 patients do not wish treatment for transplant ruptures. When grading the results according to Buck-Gramcko we found 15 excellent, 6 good, 9 fair, and 12 poor results. When using the criteria of the Committee on tendon injuries we found 11 good, 16 fair and 15 poor results. Patients' median VAS evaluation of the fingers was 30 (range 0-100) with 10 scores of 15 or below (=excellent result). Of the 43 patients, 31 would have undergone surgery if they had known the outcome in advance. Two-stage flexor tendon reconstruction takes a long time and entails many complications. Even so, it is indicated in motivated and fully