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A new technique to shorten extensor tendons in the hand
A NEW TECHNIQUE
TO S H O R T E N E X T E N S O R THE HAND
TENDONS
IN
B. VAN D E R LEI, F. K A Z E M and P. H. R O B I N S O N
From the Department of Plastic and Reconstructive Surgery, University Hospital Groningen, The Netherlands"
A new simple cut and fold technique is described, which allows precise shortening of extensor tendons in the hand by a few millimeters.
Journal of Hand Surgery (British and European Volume, 1995) 20B: 1:76 77 tendon by a few millimeters may result in a significant extension deficit impairing function (Burke et al, 1990). In such a case, surgical tendon shortening is indicated. This can be done by dividing the extensor tendon completely and resuturing it with an overlap. However, it is not easy to do this without fraying the cut ends and the small overlap may not provide adequate strength. Folding the extensor tendon without cutting it is another way to shorten the involved tendon; fraying will not occur but it is difficult to adjust the amount of shortening. We describe a new technique of shortening extensor tendons which combines the advantages of both techniques; the precision of complete tendon division with overlap and the absence of fraying of the folding technique.
Occasionally, damage to extensor tendons or extensor apparatus of the hand, either sharp or blunt, is not recognized and thus not treated adequately. This may result in secondary healing with lengthening of the involved tendon. Lengthening of such an extensor
TECHNIQUE A proximally based rectangular flap is cut in the middle of the extensor tendon, approximately one-third of its width (Fig la). This flap is lifted, mobilized, and sutured to the extensor tendon with overlap, with sufficient shortening for slight overcorrection of the extensor deficit. Mobilizing the rectangular flap over the extensor tendon automatically results in folding of the intact lateral tendon areas (Fig tb), which are then sutured in the adjusted position (Fig lc). Wound closure is per,formed with plaster immobilization for a period of 5 weeks after which the patient is instructed to perform active retraining excercises. This technique has been used with good results in four patients who had lengthening of an extensor tendon with extensor deficit due to unrecognized or inadequately
Fig 1 The "cut and fold" technique for extensor tendon shortening. (a) A centrally located proximally based rectangular flap is cut in the middle of the extensor tendon one-third of its width. (b) The rectangular flap is lifted, mobilized and sutured to the extensor tendon with overlap. (c) Mobilization of the rectangular flap over the extensor tendon automatically results in folding of the intact lateral tendon areas, which can be sutured in the adjusted position.
Table l--Patient summary and results
Case no.
Sex~age(years)
Injured/dominanthand
Trauma
~n~n
Extension lag (degrees)
Follow-up(months)
Pre-operative Post-operative 1 2 3 4
M/25 M/30 M/19 M/42
L/R R/R
L/R L/R
Blunt Blunt Sharp Sharp
EPL EDC middle finger EPL EDC middle finger EDC ring finger 76
40 15 30 25 40
5 5 0 0 5
15 15 14 9
EXTENSOR T E N D O N S H O R T E N I N G
treated blunt or sharp trauma to the dorsum of the hand (Table 1).
77
Reference BURKE, F. D., M c G R O U T H E R , D. A. and SMITH, P. J. Principles of Hand Surgery. Edinburgh, Churchill Livingstone, 1990:111.
Acknowledgment The authors wish to thank I. Stokroos for the illustration.
Accepted: 15 April 1994 Dr B. van der Lei, Department of Plastic and Reconstructive Surgery, University Hospital Groningen, Oostersingel 59, PO Box 30.001, 9700 RB Groningen, The Netherlands. © 1995 The British Society for Surgery of the Hand
TO S H O R T E N E X T E N S O R THE HAND
TENDONS
IN
B. VAN D E R LEI, F. K A Z E M and P. H. R O B I N S O N
From the Department of Plastic and Reconstructive Surgery, University Hospital Groningen, The Netherlands"
A new simple cut and fold technique is described, which allows precise shortening of extensor tendons in the hand by a few millimeters.
Journal of Hand Surgery (British and European Volume, 1995) 20B: 1:76 77 tendon by a few millimeters may result in a significant extension deficit impairing function (Burke et al, 1990). In such a case, surgical tendon shortening is indicated. This can be done by dividing the extensor tendon completely and resuturing it with an overlap. However, it is not easy to do this without fraying the cut ends and the small overlap may not provide adequate strength. Folding the extensor tendon without cutting it is another way to shorten the involved tendon; fraying will not occur but it is difficult to adjust the amount of shortening. We describe a new technique of shortening extensor tendons which combines the advantages of both techniques; the precision of complete tendon division with overlap and the absence of fraying of the folding technique.
Occasionally, damage to extensor tendons or extensor apparatus of the hand, either sharp or blunt, is not recognized and thus not treated adequately. This may result in secondary healing with lengthening of the involved tendon. Lengthening of such an extensor
TECHNIQUE A proximally based rectangular flap is cut in the middle of the extensor tendon, approximately one-third of its width (Fig la). This flap is lifted, mobilized, and sutured to the extensor tendon with overlap, with sufficient shortening for slight overcorrection of the extensor deficit. Mobilizing the rectangular flap over the extensor tendon automatically results in folding of the intact lateral tendon areas (Fig tb), which are then sutured in the adjusted position (Fig lc). Wound closure is per,formed with plaster immobilization for a period of 5 weeks after which the patient is instructed to perform active retraining excercises. This technique has been used with good results in four patients who had lengthening of an extensor tendon with extensor deficit due to unrecognized or inadequately
Fig 1 The "cut and fold" technique for extensor tendon shortening. (a) A centrally located proximally based rectangular flap is cut in the middle of the extensor tendon one-third of its width. (b) The rectangular flap is lifted, mobilized and sutured to the extensor tendon with overlap. (c) Mobilization of the rectangular flap over the extensor tendon automatically results in folding of the intact lateral tendon areas, which can be sutured in the adjusted position.
Table l--Patient summary and results
Case no.
Sex~age(years)
Injured/dominanthand
Trauma
~n~n
Extension lag (degrees)
Follow-up(months)
Pre-operative Post-operative 1 2 3 4
M/25 M/30 M/19 M/42
L/R R/R
L/R L/R
Blunt Blunt Sharp Sharp
EPL EDC middle finger EPL EDC middle finger EDC ring finger 76
40 15 30 25 40
5 5 0 0 5
15 15 14 9
EXTENSOR T E N D O N S H O R T E N I N G
treated blunt or sharp trauma to the dorsum of the hand (Table 1).
77
Reference BURKE, F. D., M c G R O U T H E R , D. A. and SMITH, P. J. Principles of Hand Surgery. Edinburgh, Churchill Livingstone, 1990:111.
Acknowledgment The authors wish to thank I. Stokroos for the illustration.
Accepted: 15 April 1994 Dr B. van der Lei, Department of Plastic and Reconstructive Surgery, University Hospital Groningen, Oostersingel 59, PO Box 30.001, 9700 RB Groningen, The Netherlands. © 1995 The British Society for Surgery of the Hand