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this is a Rashard a kiss here I'm
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discussing saggital band reconstruction
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this is a patient who had a chronically
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noted sagittal band reconstruction
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actually since childhood her recent
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complaints have been catching and
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clicking of the fingers she noted a
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tenderness on the bowler side but also
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had issues on the dorsum so we on
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examination she had obvious on her
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subluxation of the tendons has a long
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and middle finger so our incision on the
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back is such here we were making we're
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making our skin incision in a
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curvilinear type fashion skin and
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subcutaneous tissue is elevated care on
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this side is made to ensure that we
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don't disrupt any superficial nerves but
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also to identify the tenant structures
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in the systemic type manner any of
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venous structures are our cauterize is
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necessary here we're opening on the
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ulnar aspect of the common extensor as
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you can see here our plan is to sub Lux
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the the tendon radially this allows for
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visualization on on the owner side of
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the sagittal band we're now selecting on
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the radial side and here we're seeing
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the disrupted sagittal band and we can
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see scarring here from chronic tendon
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attenuation as we proceed distally care
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is taken to elevate the extensor with
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this retinaculum up off of the joint
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capsule here we're using an elevator to
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delineate the layers the capsule was
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then separated here using sharp
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dissection the extensor tendon and it's
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a sagittal banner then elevated and
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retracted on early to allow for better
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visualization we're extending this
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approximately over the metacarpal head
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to ensure that we have adequate exposure
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as well as adequate mobility of the
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tendon itself we're continuing this down
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approximately with care taken to leave a
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portion of the retinaculum for closure
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at completion at this point now we're
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taking a measurement trying to determine
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how much attendant
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can remove dis Lee in order for our
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saddlebag reconstruction we're making an
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incision along the central aspect of the
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tendon care is taken not to disrupt too
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much of the extensor tendon we usually
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try and use about a third of the tendon
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impossible we're then making it distally
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based component here where we're in
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sizing approximately at this point the
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distillate based limb is now freed
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completely of any adhesions or
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retinaculum at this point in time now we
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are looping the this portion underneath
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the common extensor and our plan will be
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to attach it to the to the intrinsic
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muscles on the radial side we're testing
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our are the tightness of our construct
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here so we've made actually an incision
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in the lateral band and looped our tenon
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through we're now testing here for any
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potential subluxation we've now brought
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the tenon back upon itself and we're now
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closing this with a three orthopod
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suture had the conclusion the finger is
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taken through a range of motion care
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throughout this was was taken to ensure
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that the retinaculum was remade without
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the inclusion of the joint capsule
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itself before final closure we we again
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checked for our appropriate range of
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motion without subluxation and here the
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ethibond is utilized to read proximate
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the tendon we then proceeded to the
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adjacent finger which also had a similar
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process you can see here again the
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subluxation is improved slightly because
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of the juncture to the long finger
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however there is there is attenuation on
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the radial side at this point in time
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we're again taking the length that is
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required to reach the radial intrinsics
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we're then using this length to to
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approximate our distally based flap the
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canada longitudinal incision is made to
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center portion of the tendon
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then this portion is transected and then
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passed beneath the tendon in effort to
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bring it through our limb in order to
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bring it back and we approximate it so
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to the tendon here again we're placing
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your suture again we try and place one
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or two sutures and then confirm our
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centralization before we place all of
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the - all of the sutures here this
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concludes the procedure all the sutures
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have been placed the centralization has
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been achieved the skin is enclosed in a
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systematic fashion using a mattress type
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suture I typically use a three own I'll
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own this in this scenario the patient is
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placed in extension splints