Tendon graft dnb ms question with answer - DNB Orthopaedics MS Orthopedics MRCS Exam GUIDE - Orthodnb.com

DNB Orthopaedics  MS Orthopedics  MRCS Exam GUIDE - Orthodnb.com

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Sunday 14 May 2017

Tendon graft dnb ms question with answer


  • used when tendon ends can not be approximated at the time of repair
Single stage tendon graft
  • Indications
    • delay in repair, esp flexor tendons of hand (proximal end of tendon necrotic)
    • segmental lose of tendon ends
    • gap can not be closed because of myocontracture
  • Pre requisites
    • complete wound healing
    • adequate soft tissue coverage
    • absence of edema and induration
    • skeletal alignment satisfactory and stable and full range of passive motion for all joints
    • sensation normal or at least one digital nerve intact in fingers

  • Contraindications
    • adherent extensor tendons
    • planned capsulotomy for stiff joints
    • need for pulley reconstruction
Two stage tendon graft
  • I stage
    • excising the tendon ends and scar tissue from tendon bed
    • preserving the pulley system and reconstructing it if necessary
    • dacron impregnated silicone rod inserted to maintain the tunnel in area of excised tendons
  • II stage
    • rod removed and tendon graft inserted
  • Indications
    • severely scarred wound bed and bone exposure
    • simultaneous fracture fixation
    • both repair of flexor and extensor tendons
    • repair of A2 or A4 pulley
    • joint stiffness when capsulotomy planned
    • when local finger flap is needed
    • failed zone II tendon repair
Donor sites
  • palmaris longus
    • easy access, no functional loss and good caliber for digit flexors
    • may be absent in 10% persons
  • plantaris tendon
    • long tendon, no functional loss
    • can be easily braided if thicker graft is required
    • less accessible, absent in 20% persons
    • no test to determine its presence pre op
  • extensor digitorum longus
  • extensor indicis proprius
  • flexor digitorum superficialis
  • tendon grafts harvested from an irreparably injured structures
Tendon substitutes
  • allograft
    • tendons contain minimal cellular elements- so less antigenicity – decreases the risk of fibrosis from immunologic reaction
  • synthetic graft replacements
    • replacements made from dacron, expanded poly tetra fluro ethylene, carbon fibre, woven nylon
    • needed properties : biocompatibility, properties of the implant, ability to withstand repetitive stress, fixation of implant
  • lumbrical plus finger
    • graft tension less – graft too long
    • seen in free tendon graft for FDP zone II injury
    • pull of profundus musculotendinous unit applied through lumbricals than flexor tendon graft – which is distal to lumbrical origin
    • pull on lumbricals cause extension of IP joints
    • gentle flexion – patient makes a fist
    • fast powerful flexion – IP joint extends in paradoxical extension
    • treatment : resection of involved lumbrical tendon
  • quadriga effect
    • tendon graft too tight – increased tension
    • during flexion – grafted finger flexes more than other fingers and reaches palm first – limits the flexion ability of other fingers
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