Archives of Plastic Surgery

  • 제51권1호
  • /
  • Pages.118-125
  • /
  • 2024
  • /
  • 2234-6163(pISSN)
  • /
  • 2234-6171(eISSN)
대한성형외과학회 (Korean Society of Plastic and Reconstructive Surgeons)
권호 표지
DOI QR코드

DOI QR Code

Staged Tendon Repair to Improve Range of Motion in Tamai Zone 4 Replantation: Two Case Reports

  • Takeo Matsusue (Department of Plastic Reconstructive Surgery, Kansai Electric Power Hospital)
  • 투고 : 2022.07.28
  • 심사 : 2023.10.07
  • 발행 : 2024.01.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Tamai zone 4 replantation, defined as the replantation at a level proximal to the flexor digitorum superficialis' insertion and distal to where the common digital artery branches into the proper digital artery, has poor functional results because making orthosis and rehabilitation protocols that protect the bone and the flexor and extensor tendons simultaneously difficult. Two cases of Tamai zone 4 replantation are presented: one case of an index finger replantation at the proximal phalanx and a case of ring finger replantation at the proximal interphalangeal joint. The author did not repair the flexor tendon intentionally in the primary replantation and performed two-stage flexor tendon reconstruction later. The total active motions (TAMs) at the last follow-up were 215 and 180 degrees, respectively, with the latter distal interphalangeal joint being an arthrodesis. Both cases had no extension lag in the proximal interphalangeal joint. These results were much better than those in previous reports, in which the mean TAM was 133 degrees or less. The good results appeared to be mainly due to the reasonable and clear postoperative rehabilitation protocols made by the proposed procedure. This procedure may be useful for obtaining reproducible functional results even in Tamai zone 4 replantation.

키워드

참고문헌

  1. Howell JW, Peck F. Rehabilitation of flexor and extensor tendon injuries in the hand: current updates. Injury 2013;44(03):397-402 
  2. Tamai S, Hori Y, Tatsumi Y, et al. Microvascular anastomosis and its application on the replantation of amputated digits and hands. Clin Orthop Relat Res 1978;(133):106-121 
  3. Ross DC, Manktelow RT, Wells MT, Boyd JB. Tendon function after replantation: prognostic factors and strategies to enhance total active motion. Ann Plast Surg 2003;51(02):141-146 
  4. Woo SH. Practical tips to improve efficiency and success in upper limb replantation. Plast Reconstr Surg 2019;144(05):878e-911e 
  5. Higgins JP. Replantation and transplantation. In: Wolfe SW, Pederson WC, Kozin SH, et al., eds. Green's Operative Hand Surgery. 8th ed. Philadelphia: Elsevier; 2022:1653-1662 
  6. Silverman PM, Willette-Green V, Petrilli J. Early protective motion in digital revascularization and replantation. J Hand Ther 1989;2:84-101 
  7. Seiler JG III. Flexor tendon injury. In: Wolfe SW, Pederson WC, Kozin SH, et al., eds. Green's Operative Hand Surgery. 8th ed. Philadelphia: Elsevier; 2022:212-259 
  8. Strauch RJ. Extensor tendon injury. In: Wolfe SW, Pederson WC, Kozin SH, et al., eds. Green's Operative Hand Surgery. 8th ed. Philadelphia: Elsevier; 2022:182-211 
  9. Cetin A, Dincer F, Kecik A, Cetin M. Rehabilitation of flexor tendon injuries by use of a combined regimen of modified Kleinert and modified Duran techniques. Am J Phys Med Rehabil 2001;80(10):721-728 
  10. Bell-Krotoski J, Tomancik E. The repeatability of testing with Semmes-Weinstein monofilaments. J Hand Surg Am 1987;12(01):155-161 
  11. Moberg E. The unresolved problem - how to test the functional value of hand sensibility. J Hand Ther 1991;4:105-110 
  12. Chen J, Zhang AX, Chen QZ, Mu S, Tan J. Long-term functional, subjective and psychological results after single digit replantation. Acta Orthop Traumatol Turc 2018;52(02):120-126 
  13. Buntic RF, Brooks D, Buncke GM. Index finger salvage with replantation and revascularization: revisiting conventional wisdom. Microsurgery 2008;28(08):612-616 
  14. Ugurlar M, Kabakas F, Purisa H, Sezer I, Celikdelen P, Ozcelik IB. Rehabilitation after successful finger replantation. North Clin Istanb 2016;3(01):22-26 
  15. Scott FA, Howar JW, Boswick JA Jr. Recovery of function following replantation and revascularization of amputated hand parts. J Trauma 1981;21(03):204-214 
  16. Cheng SL, Chuang DC, Tung TC, Wei FC. Successful replantation of an avulsed middle finger. Ann Plast Surg 1998;41(06):662-666 
  17. Griffin M, Hindocha S, Jordan D, Saleh M, Khan W. An overview of the management of flexor tendon injuries. Open Orthop J 2012;6:28-35 
  18. Kotwal PP, Ansari MT. Zone 2 flexor tendon injuries: venturing into the no man's land. Indian J Orthop 2012;46(06):608-615 
  19. Abdul-Kader MH, Amin MA. Two-stage reconstruction for flexor tendon injuries in zone II using a silicone rod and pedicled sublimis tendon graft. Indian J Plast Surg 2010;43(01):14-20 
  20. Ju J, Li L, Hou R. Transplantation of a free vascularized joint flap from the second toe for the acute reconstruction of defects in the thumb and other fingers. Indian J Orthop 2019;53(02):357-365