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Acute A4 Pulley Reconstruction with a First Extensor Compartment Onlay Graft

BACKGROUND: The integrity of the flexor tendon pulley apparatus is crucial for unimpaired function of the digits. Although secondary reconstruction is an established procedure in multi-pulley injuries, acute reconstruction of isolated, closed pulley ruptures is a rare occurrence. There are 3 factors...

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Autores principales: Jakubietz, Michael G., Meffert, Rainer H., Schmidt, Karsten, Gruenert, Joerg G., Jakubietz, Rafael G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505836/
https://www.ncbi.nlm.nih.gov/pubmed/28740775
http://dx.doi.org/10.1097/GOX.0000000000001361
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author Jakubietz, Michael G.
Meffert, Rainer H.
Schmidt, Karsten
Gruenert, Joerg G.
Jakubietz, Rafael G.
author_facet Jakubietz, Michael G.
Meffert, Rainer H.
Schmidt, Karsten
Gruenert, Joerg G.
Jakubietz, Rafael G.
author_sort Jakubietz, Michael G.
collection PubMed
description BACKGROUND: The integrity of the flexor tendon pulley apparatus is crucial for unimpaired function of the digits. Although secondary reconstruction is an established procedure in multi-pulley injuries, acute reconstruction of isolated, closed pulley ruptures is a rare occurrence. There are 3 factors influencing the functional outcome of a reconstruction: gapping distance between tendon and bone (E-space), bulkiness of the reconstruction, and stability. As direct repair is rarely done, grafts are used to reinforce the pulley. An advantage of the first extensor retinaculum graft is the synovial coating providing the possibility to be used both as a direct graft with synovial coating or as an onlay graft after removal of the synovia when the native synovial layer is present. METHODS: A graft from the first dorsal extensor compartment is used as an onlay graft to reinforce the sutured A4 pulley. This technique allows reconstruction of the original dimensions of the pulley system while stability is ensured by anchoring the onlay graft to the bony insertions of the pulley. RESULTS: Anatomical reconstruction can be achieved with this method. The measured E-space remained 0 mm throughout the recovery, while the graft incorporated as a slim reinforcement of the pulley, displaying no bulkiness. CONCLUSIONS: The ideal reconstruction should provide synovial coating and sufficient strength with minimal bulk. Early reconstruction using an onlay graft offers these options. The native synovial lining is preserved and the graft is used to reinforce the pulley.
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spelling pubmed-55058362017-07-24 Acute A4 Pulley Reconstruction with a First Extensor Compartment Onlay Graft Jakubietz, Michael G. Meffert, Rainer H. Schmidt, Karsten Gruenert, Joerg G. Jakubietz, Rafael G. Plast Reconstr Surg Glob Open Original Article BACKGROUND: The integrity of the flexor tendon pulley apparatus is crucial for unimpaired function of the digits. Although secondary reconstruction is an established procedure in multi-pulley injuries, acute reconstruction of isolated, closed pulley ruptures is a rare occurrence. There are 3 factors influencing the functional outcome of a reconstruction: gapping distance between tendon and bone (E-space), bulkiness of the reconstruction, and stability. As direct repair is rarely done, grafts are used to reinforce the pulley. An advantage of the first extensor retinaculum graft is the synovial coating providing the possibility to be used both as a direct graft with synovial coating or as an onlay graft after removal of the synovia when the native synovial layer is present. METHODS: A graft from the first dorsal extensor compartment is used as an onlay graft to reinforce the sutured A4 pulley. This technique allows reconstruction of the original dimensions of the pulley system while stability is ensured by anchoring the onlay graft to the bony insertions of the pulley. RESULTS: Anatomical reconstruction can be achieved with this method. The measured E-space remained 0 mm throughout the recovery, while the graft incorporated as a slim reinforcement of the pulley, displaying no bulkiness. CONCLUSIONS: The ideal reconstruction should provide synovial coating and sufficient strength with minimal bulk. Early reconstruction using an onlay graft offers these options. The native synovial lining is preserved and the graft is used to reinforce the pulley. Wolters Kluwer Health 2017-06-28 /pmc/articles/PMC5505836/ /pubmed/28740775 http://dx.doi.org/10.1097/GOX.0000000000001361 Text en Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Original Article
Jakubietz, Michael G.
Meffert, Rainer H.
Schmidt, Karsten
Gruenert, Joerg G.
Jakubietz, Rafael G.
Acute A4 Pulley Reconstruction with a First Extensor Compartment Onlay Graft
title Acute A4 Pulley Reconstruction with a First Extensor Compartment Onlay Graft
title_full Acute A4 Pulley Reconstruction with a First Extensor Compartment Onlay Graft
title_fullStr Acute A4 Pulley Reconstruction with a First Extensor Compartment Onlay Graft
title_full_unstemmed Acute A4 Pulley Reconstruction with a First Extensor Compartment Onlay Graft
title_short Acute A4 Pulley Reconstruction with a First Extensor Compartment Onlay Graft
title_sort acute a4 pulley reconstruction with a first extensor compartment onlay graft
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505836/
https://www.ncbi.nlm.nih.gov/pubmed/28740775
http://dx.doi.org/10.1097/GOX.0000000000001361
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