- Email: [email protected]
Cut palmaris longus tendon—To repair or not to repair?
Cut Pa!maris T e n d o n - - T o Repair or Not to Repair?--K. Sarangapani ~and H. G, Brown
C U T P A L M A R I S L O N G U S T E N D O N - - T O R E P A I R OR N O T T O R E P A I R ?
K. S A R A N G A P A N I and H. G. BROWN, Newcastle-upon-Tyne SUMMARY It is suggested in certain circumstances, that a divided palmaris longus tendon should be repaired, as it is an ideal choice for a tendon graft, or could be of use as a tendon transfer. The musculotendinous unit may be of use as an autogenons free graft. INTRODUCTION
Of all the "spare part" tendons for use as a tendon graft, that of palmaris longus is considered to be the ideal choice (Rank and Wakefield, 1951), yet when it is divided it is said to be of little importance (Verdan, 1975) and presumably need not be repaired. While a divided palmaris longus tendon is probably of no functional significance we feel that it may be beneficial to the patient as the repaired tendon may be required on a future occasion. Otherwise it is rather like carrying a punctured spare tyre in a car. The second choice for a tendon graft is plantaris and pre-operative confirmation of its presence is rarely possible. Hence we advocate the repair of palmaris longus tendon when it is divided. The repair should be considered if the cut is single and at the wrist or at the musculotendinous junction. Once the tendon is cut, the muscle will retract and the tendon may curl up ending in a mass which will be unusable later. It is also possible that palmaris longus tendon may have to be used during a tendon transfer (Thomsen and Rasmussen, 1969) or the musculotendinous unit as a free autogenous transplant in certain cases of facial paralysis (Thompson, 1971 and Hakelius, 1974).
p.I. deep fascia
f.d.s. //~
\
f.d.p. f c.u
median n. ~ ~ " ~ f.c.r.--______Jj~} ~ fpl..,
~
~
"-~'~
~
~
ulnarn,
Fig. 1. Showsthe relation of palmaris longus tendon to the other flexors at wrist. K. SARANGAPANI, M.S., F.R.C.S., The Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne, NE1 4LP. 86
The Hand--Vol, 9
No. 1
1977
Cut Palmaris T e n d o n P T o Repair or Not to Repair?--K. Sarangapani and H. G. Brown
ANATOMY
Because palmaris longus tendon is situated in a superficial plane within the deep fascia and is well separated from the rest of the flexors (Fig. 1) by the flexor retinaculum at the wrist, adhesions between the various tendons are less likely. MATERIALS AND METHODS
We have carried out the repair of palmaris longus tendon in multiple tendon injuries at the wrist in twelve cases. The type of repair is a modified Bunnell with 4/0 nylon suture. As it is part of other tendon repairs, there is no special postoperative management. RESULTS
All the repaired palmaris tendons healed without any complications. We have as yet, had no opportunity to use the repaired palmaris longus tendon as a graft, but it is not unusual to see reported the need of a tendon graft when primary tendon repair has failed. An unrepaired cut palmaris longus tendon serves no useful purpose and it is better to save it than waste it. ACKNOWLEDGEMENTS
We would like to thank Mr. J. R. G. Edwards, Mr. T. A. Piggot and Mr. D. A. Crockford for allowing us to include patients admitted under their care, and to Mr. D. Hammersley of the Graphics Department of the University of Newcastle-upon-Tyne for the illustration, and to Mrs. M. E. Shepherd for typing the manuscript. REFERENCES
HAKELIUS, L. (1974) Transplantation of free autogenous muscle in the treatment of facial paralysis. A clinical study. Scandinavian Journal of Plastic and Reconstructive Surgery, 8: 220-230. RANK, B. K. and WAKEFIELD, A. R. (1951) The Repair Of Flexor Tendons In The Hand. British Journal of Plastic Surgery, 4: 244-253. THOMSEN, M. and RASMUSSEN, K. B. (1969) Tendon transfers for defective long extensors of the wrist and fingers. Scandinavian Journal of Plastic and Reconstructive Surgery, 3: 71-78. THOMPSON, N. (1971) Treatment of Facial Paralysis by Free Skeletal Muscle Grafts, in Transactions of Fifth World Congress of Plastic and Reconstructive Surgery (Melbourne, 1971). Butterworths, Australia, p. 66. VERDAN, C. E. (1975) Primary and Secondary Repair of Flexor and Extensor Tendon Injuries. Hand Surgery, Edited by Flynn, J. E., Second Edition, Baltimore, The Williams and Wilkins Company, p. 154.
The Hand--Vol. 9
No. 1
1977
87
C U T P A L M A R I S L O N G U S T E N D O N - - T O R E P A I R OR N O T T O R E P A I R ?
K. S A R A N G A P A N I and H. G. BROWN, Newcastle-upon-Tyne SUMMARY It is suggested in certain circumstances, that a divided palmaris longus tendon should be repaired, as it is an ideal choice for a tendon graft, or could be of use as a tendon transfer. The musculotendinous unit may be of use as an autogenons free graft. INTRODUCTION
Of all the "spare part" tendons for use as a tendon graft, that of palmaris longus is considered to be the ideal choice (Rank and Wakefield, 1951), yet when it is divided it is said to be of little importance (Verdan, 1975) and presumably need not be repaired. While a divided palmaris longus tendon is probably of no functional significance we feel that it may be beneficial to the patient as the repaired tendon may be required on a future occasion. Otherwise it is rather like carrying a punctured spare tyre in a car. The second choice for a tendon graft is plantaris and pre-operative confirmation of its presence is rarely possible. Hence we advocate the repair of palmaris longus tendon when it is divided. The repair should be considered if the cut is single and at the wrist or at the musculotendinous junction. Once the tendon is cut, the muscle will retract and the tendon may curl up ending in a mass which will be unusable later. It is also possible that palmaris longus tendon may have to be used during a tendon transfer (Thomsen and Rasmussen, 1969) or the musculotendinous unit as a free autogenous transplant in certain cases of facial paralysis (Thompson, 1971 and Hakelius, 1974).
p.I. deep fascia
f.d.s. //~
\
f.d.p. f c.u
median n. ~ ~ " ~ f.c.r.--______Jj~} ~ fpl..,
~
~
"-~'~
~
~
ulnarn,
Fig. 1. Showsthe relation of palmaris longus tendon to the other flexors at wrist. K. SARANGAPANI, M.S., F.R.C.S., The Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne, NE1 4LP. 86
The Hand--Vol, 9
No. 1
1977
Cut Palmaris T e n d o n P T o Repair or Not to Repair?--K. Sarangapani and H. G. Brown
ANATOMY
Because palmaris longus tendon is situated in a superficial plane within the deep fascia and is well separated from the rest of the flexors (Fig. 1) by the flexor retinaculum at the wrist, adhesions between the various tendons are less likely. MATERIALS AND METHODS
We have carried out the repair of palmaris longus tendon in multiple tendon injuries at the wrist in twelve cases. The type of repair is a modified Bunnell with 4/0 nylon suture. As it is part of other tendon repairs, there is no special postoperative management. RESULTS
All the repaired palmaris tendons healed without any complications. We have as yet, had no opportunity to use the repaired palmaris longus tendon as a graft, but it is not unusual to see reported the need of a tendon graft when primary tendon repair has failed. An unrepaired cut palmaris longus tendon serves no useful purpose and it is better to save it than waste it. ACKNOWLEDGEMENTS
We would like to thank Mr. J. R. G. Edwards, Mr. T. A. Piggot and Mr. D. A. Crockford for allowing us to include patients admitted under their care, and to Mr. D. Hammersley of the Graphics Department of the University of Newcastle-upon-Tyne for the illustration, and to Mrs. M. E. Shepherd for typing the manuscript. REFERENCES
HAKELIUS, L. (1974) Transplantation of free autogenous muscle in the treatment of facial paralysis. A clinical study. Scandinavian Journal of Plastic and Reconstructive Surgery, 8: 220-230. RANK, B. K. and WAKEFIELD, A. R. (1951) The Repair Of Flexor Tendons In The Hand. British Journal of Plastic Surgery, 4: 244-253. THOMSEN, M. and RASMUSSEN, K. B. (1969) Tendon transfers for defective long extensors of the wrist and fingers. Scandinavian Journal of Plastic and Reconstructive Surgery, 3: 71-78. THOMPSON, N. (1971) Treatment of Facial Paralysis by Free Skeletal Muscle Grafts, in Transactions of Fifth World Congress of Plastic and Reconstructive Surgery (Melbourne, 1971). Butterworths, Australia, p. 66. VERDAN, C. E. (1975) Primary and Secondary Repair of Flexor and Extensor Tendon Injuries. Hand Surgery, Edited by Flynn, J. E., Second Edition, Baltimore, The Williams and Wilkins Company, p. 154.
The Hand--Vol. 9
No. 1
1977
87