Flexor Tendon Grafting as Reoperative Procedure for Injuries within Fingers and Thumb

Abstract

Background. The reoperation rate reported in the literature in cases of flexor tendon injuries within the fingers and thumb is about 20%, but the functional results of these reoperations are barely discussed. The aim of the study was to evaluate the results of flexor tendon grafting performed as a redo procedure in patients who had previously underwent unsuccessful flexor tendon surgery. Methods. This study reports the outcomes of deep flexor tendon and flexor pollicis longus tendon grafting in 122 fingers of 109 patients depending on two factors — the type of the first failed surgery (tendon suture in 51 fingers vs grafting in 71 fingers) and the type of the medical unit where the failed procedure had been performed (hand surgery department in 76 cases vs general trauma unit in 46 cases). Results. Our reoperative grafting procedures led to excellent results in 13 fingers of 51 (25.5% [95% CI: 14–40]) after failed tendon suture and in 32 fingers of 71 (45.1% [95% CI: 33–57]) after failed previous grafting, difference is statistically significant (÷2 = 4.888; p = 0.027). Failed surgeries performed at the hand surgery departments were redone with 48.7% [95% CI: 37–60] of excellent results (in 37 fingers of 76) and 14.5% [95% CI: 7–24] of fair results (in 11 fingers of 76). Failed surgeries performed at the general trauma units were redone with 17.4% [95% CI: 8–31] of excellent results (in 8 fingers of 46). This value statistically significantly differed from the hand surgery departments group: ÷2 = 12.054; p = 0.001. For a total, excellent results were obtained in 36.9% [95% CI: 28–46] (in 45 fingers of 122) of reoperative grafting procedures and good results in 34.5% [95% CI: 26–43] (in 42 fingers of 122). Conclusions. Analysis of the functional results of deep flexor tendon and flexor pollicis longus tendon grafting performed as a reoperative procedure showed that the excellent results with full finger function were achievable in patients who had previously undergone unsuccessful flexor tendon surgery in zone 2. But in general, the rates of motion recovery were significantly lower than in uncomplicated cases, even with a long history of injury. The worst functional results of reoperations were in patients who had previously been unsuccessfully operated in non-specialized medical units.