Turnover Technique Aids Hand Tendon Reconstruction

A novel tendon lengthening technique avoids the additional morbidity and complications associated with grafting, transfers, and two stage reconstructions.

Researchers at St. George's Healthcare NHS Trust (London, United Kingdom) have developed a turnover lengthening technique for hand tendons that is quick, simple, and reproducible for defects not exceeding 3 to 4 centimeters, provides a means of immediate one stage reconstruction, does not involve secondary donor site morbidity, and does not compromise salvage by tendon transfer and/or two-stage reconstruction in cases of failure.

The technique involves access to the injured tendon and severed ends by careful and atraumatic surgical technique. The donor tendon stump is incised in an “L-shape” fashion, allowing longitudinal splitting of approximately 50% of the tendon circumference; sufficient tendon length must be ensured to bridge the gap after 180° of tendon turnover. The length of tendon turnover donor stump is calculated bearing in mind that tendon splitting should stop 0.5–1.0 cm from the lacerated end so that enough, yet not too much of the tendon substance is left for pedicle reinforcement at the point of tendon turnover with appropriate sutures.

The exposed tendon core of the donor site and turnover stump are then tubularized with continuous epitendonous approximating sutures, and the tubularized tendon turnover stump is anastomosed to the recipient tendon stump to reinforce the turnover site, reinstate epitendonous continuity, reduce adhesion formation and obviate the added cost and unpredictability of acellular dermal matrix use. The authors stress that decreasing the tendon cross-sectional diameter by 50% is biomechanically safe, and in keeping with current literature. The study was published in the July 2013 issue of Journal of Plastic, Reconstructive & Aesthetic Surgery.

“The technique has successfully been applied to the repair of several cases, including a case of attritional flexor and traumatic extensor tendon rupture in two presented patients where primary tenorrhaphy was not possible,” concluded study coauthor, consultant plastic surgeon Sonja Cerovac, MD. “In both cases a good postoperative outcome was achieved, as the patients were happy having returned back to normal activities of daily living such that they were discharged 12 weeks postoperatively.”

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St. George's Healthcare NHS Trust