so Shari Dacus today I'm going to
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discuss stage one reconstruction for
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chronic flexor tendon laceration here we
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have an illustration of the small finger
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we can see evidence of lack of Tina
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veces I began with the transverse
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incision in the in the along the a1
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pulley here we're drawing out our carpal
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tunnel you can see the hook of the
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hamate has been drawn we use the carpal
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tunnel as a potential area for passing
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our hunter rod and also an area for
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evaluating our flexor tendons if
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necessary in ceará Berner incision
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extending approximately this is a
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patient whose MRI confirmed laceration
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at the area of the metacarpal head here
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I'm making drawing our area in the
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forearm here this is where our hunter
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rod will be placed along the area of the
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FTP to the ring finger if possible so
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here we begin with our transverse
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incision
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well then extend our burn approximately
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then use a double hook to elevate our
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our corners and then we dissect through
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the subcutaneous tissue down to the
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flexor sheath well identify the a1
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pulley at that point and then we'll open
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the a1 pulley to try and attempt to find
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our flexor tendons here we can we've
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identified our flexor tendon and we can
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see its attachment distally we know
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based on our MRI that there's a
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disruption proximal over this area and
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so we're dissecting through and you can
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see chronic inflammatory and fit meanest
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issue from our tendon disruption the
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tenant will not be delivered distally
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and again you can see the chronic
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disruption from the tendon and that's
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our proximal edge which we just
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visualized you can tell the tendon has
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been chronically disrupted you can see
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how the tendon edge is sealed off and
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it's somewhat of a ball type fashion so
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all adhesion is removed again we can see
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the tendon being cooled distally distal
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attachment is intact I was a place in
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the freer and
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the flexor tendon sheath will now open
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the carpal tunnel the flexor uh the
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flexor retinaculum is incised and with
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this will open the transverse carpal
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ligament using sharp retractors here
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were able to pull the a fatty adipose
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tissue out of the way and now we can
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open the carpal tunnel I use blunt
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scissors in this in this scenario here
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to ensure that we don't disrupt anything
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distally and now we're passing a
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flexible tendon passer through the
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sheath into the carpal tunnel and then
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distally and then sorry than
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approximately into the forearm we've now
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identified where our tendon will be
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passed and make a longitudinal incision
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here in the forearm the subcutaneous
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tissue is divided and then the flexor
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affects our mass is then identified the
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fashion is released we're now flexing
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extending the ring finger to identify
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the the muscle bellies we're now going
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deep to the FDS in order to find the FTP
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tendons here you can see the common
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muscle belly and the common tenderness
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attachments we're dissecting here and
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that this area illustrates where the
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previous tenant disruption was now you
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can see our incisions we will now take a
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hunter rod in a small finger we tend to
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use a size three as this is small enough
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for the tendon to be passed the hunter
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rod hasn't passed through the carpal
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tunnel and proximately into the forearm
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once it is placed we ensure that it is
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placed in an area where the FDP tendons
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are located we then removed the residual
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Fitness tissue from the end of the
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distal stump and in approximate the
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hunter rod to the distal stop using a
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Kessler type suture with a 308 the bond
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this is sutured with care to ensure that
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we have in the end approximation and
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then overlap suture with a figure eight
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approximately the hunter rod is cut to a
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point where it can now move without
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kinking in the form the fingers flexed
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and extended to ensure that the hunter
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rod moves smoothly this concludes the
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procedure