00:01 this is a Rashard a kiss here I'm 00:03 discussing saggital band reconstruction 00:07 this is a patient who had a chronically 00:10 noted sagittal band reconstruction 00:12 actually since childhood her recent 00:15 complaints have been catching and 00:16 clicking of the fingers she noted a 00:18 tenderness on the bowler side but also 00:21 had issues on the dorsum so we on 00:23 examination she had obvious on her 00:25 subluxation of the tendons has a long 00:27 and middle finger so our incision on the 00:29 back is such here we were making we're 00:32 making our skin incision in a 00:33 curvilinear type fashion skin and 00:36 subcutaneous tissue is elevated care on 00:38 this side is made to ensure that we 00:41 don't disrupt any superficial nerves but 00:43 also to identify the tenant structures 00:46 in the systemic type manner any of 00:50 venous structures are our cauterize is 00:53 necessary here we're opening on the 00:55 ulnar aspect of the common extensor as 01:00 you can see here our plan is to sub Lux 01:02 the the tendon radially this allows for 01:05 visualization on on the owner side of 01:08 the sagittal band we're now selecting on 01:12 the radial side and here we're seeing 01:14 the disrupted sagittal band and we can 01:18 see scarring here from chronic tendon 01:21 attenuation as we proceed distally care 01:25 is taken to elevate the extensor with 01:28 this retinaculum up off of the joint 01:30 capsule here we're using an elevator to 01:33 delineate the layers the capsule was 01:37 then separated here using sharp 01:39 dissection the extensor tendon and it's 01:42 a sagittal banner then elevated and 01:45 retracted on early to allow for better 01:48 visualization we're extending this 01:51 approximately over the metacarpal head 01:53 to ensure that we have adequate exposure 01:55 as well as adequate mobility of the 01:58 tendon itself we're continuing this down 02:01 approximately with care taken to leave a 02:03 portion of the retinaculum for closure 02:06 at completion at this point now we're 02:09 taking a measurement trying to determine 02:11 how much attendant 02:13 can remove dis Lee in order for our 02:16 saddlebag reconstruction we're making an 02:19 incision along the central aspect of the 02:21 tendon care is taken not to disrupt too 02:23 much of the extensor tendon we usually 02:26 try and use about a third of the tendon 02:27 impossible we're then making it distally 02:30 based component here where we're in 02:33 sizing approximately at this point the 02:37 distillate based limb is now freed 02:39 completely of any adhesions or 02:42 retinaculum at this point in time now we 02:47 are looping the this portion underneath 02:50 the common extensor and our plan will be 02:53 to attach it to the to the intrinsic 02:56 muscles on the radial side we're testing 03:00 our are the tightness of our construct 03:03 here so we've made actually an incision 03:05 in the lateral band and looped our tenon 03:07 through we're now testing here for any 03:10 potential subluxation we've now brought 03:13 the tenon back upon itself and we're now 03:15 closing this with a three orthopod 03:17 suture had the conclusion the finger is 03:22 taken through a range of motion care 03:24 throughout this was was taken to ensure 03:26 that the retinaculum was remade without 03:30 the inclusion of the joint capsule 03:31 itself before final closure we we again 03:35 checked for our appropriate range of 03:37 motion without subluxation and here the 03:39 ethibond is utilized to read proximate 03:41 the tendon we then proceeded to the 03:44 adjacent finger which also had a similar 03:46 process you can see here again the 03:50 subluxation is improved slightly because 03:52 of the juncture to the long finger 03:54 however there is there is attenuation on 03:57 the radial side at this point in time 04:01 we're again taking the length that is 04:04 required to reach the radial intrinsics 04:08 we're then using this length to to 04:11 approximate our distally based flap the 04:15 canada longitudinal incision is made to 04:17 center portion of the tendon 04:22 then this portion is transected and then 04:25 passed beneath the tendon in effort to 04:28 bring it through our limb in order to 04:33 bring it back and we approximate it so 04:35 to the tendon here again we're placing 04:38 your suture again we try and place one 04:41 or two sutures and then confirm our 04:43 centralization before we place all of 04:45 the - all of the sutures here this 04:47 concludes the procedure all the sutures 04:49 have been placed the centralization has 04:51 been achieved the skin is enclosed in a 04:54 systematic fashion using a mattress type 04:56 suture I typically use a three own I'll 04:59 own this in this scenario the patient is 05:02 placed in extension splints