Flexor-Tendon Reconstruction in Severely Damaged Hands

Our experience with a Dacron-reinforced silicone tendon prosthesis in the reconstruction of flexor tendons of the hand, first reported in 1965, is brought up to date. Currently the prosthesis is usually used as a passive gliding device which is attached only to the distal phalanx. This implant, inserted as the first stage of a two-stage procedure in conjunction with excision of scar and the reconstruction of a proper pulley system, has been demonstrated to stimulate the formation of a sheath Which provides a durable gliding surface and a nutritional mechanism for a tendon graft which begins to glide early. The indications for this procedure, as well as the preoperative, operative, and postoperative management, are described. The results in five thumbs and sixty-nine fingers, all with less than good conditions for tendon grafting (Boyes' Grades 2, 3, and 5), after follow-ups ranging from six months to eight years, are presented. The complications are also described. The results are compared with those in previously reported comparable cases. The distinctly better results obtained in our series lead us to conclude that the two-stage procedure described is the one of choice for properly selected old injuries where the conditions are less than optimum for tendon grafting.