Single Stage Flexor Tendon Reconstruction with Silastic

SINGLE-STAGE FLEXOR TENDON RECONSTRUCTION WITH SILASTIC

Authors:

1.     Ricardo Galðn, MD. MSc. Plastic Surgeon. Hand Surgeon.

2.     Diego Arango, MD. Plastic surgery Resident

3.     Jhon Fredy Castañeda L, MD. Orthopedist. Hand Surgeon

4.     German Hernandez, MD. Orthopedist Hand Surgeon

Background

Tendon grafts have been described in a two-stage proce.dure.^1,2 The first stage involves placing the Silastic tendon to form a new tendon sheath. On the second stage takes place the extraction of the Silastic tendon and placing a tendon autograft. ^3.4The idea of using a single procedure arose after a case where the extraction of the implant was declined by the patient (good result, absence of symptoms and great function). The objective of this paper was to evaluate clinical and functional results after the management with a single-stage procedure in flexor tendon after chronic injuries using an active Silastic implant and, analyzing biomechanical behavior of the Silastic implant to establish this treatment as a viable permanent option.

Methods

A descriptive cross-section study was designed.  First personal evaluation was done between February and March 2010. A second evaluation with a personal interview between May and July 2017.  Follow-up period of more than 10 years with a total of 38 patients included. Univariate and Bivariate Analysis were done. Statistical significance Determination (p<0.05). The tendon was submitted to a series of tests to measure the deformation effort and its rupture load.

Results

A total of 38 patients were included.  Average age  was 35.4 years. Predominance in males (60.5%), right handed patients (57.9%). A total of 63.2% had >10 year follow-up period, with an average of 10.8 years. The average follow-up was 8.2 years with a range between 1.2-12.8 years. Greater thumb (31.6%) and index finger (23.7%) involvement. No statistical relation with the final result (p<0.005). There was a modification in function in 100% of patients. Postoperative pain was minimal, average score was 1 (Visual Analogue Scale).  Four patients required early removal of the graft. These patients required a second procedure with conventional technique and palmaris longus graft with great results. Minor complications were found in 7.9%  of the cases.  Final evaluation with the DASH scale showed a general average of 3.4

Conclusions

This is the first Case-Series with this treatment with a follow-up period of >10 years. ItÂxs a safe procedure with excellent results in this experience (adequate mobility and Functional recovery). Improvement of 124º in thumbs and 107º other fingers.  Mobility Improvement in all cases, with better results in thumbs.  In general is a Safe procedure with few complications. With the advantage of only performing a 1 stage surgery and a faster recovery.

Bibliography.

1. Strickland JW.  Delayed Treatment of Flexor Tendon Injuries  Hand Clin 21 (2005) 219--243.

2. Strickland   JW. Flexor Tendon Injuries: I. Foundations of Treatment.  J Am Acad Orthop Surg 1995;3:44-54  

3. Hunter JM. Artificial tendons: early development and application. Am J Surg.  1965; 109:325Y338.

4. Hunter JM, Flexor tendon reconstruction in severely damaged hands: a two staged pdroceure using a silicon. reinforced gliding prosthesis prior to tendon grafting. J Bone Joint Surg. 1971;53A:829Y858