Flexor Carpi Radialis to Extensor Digitorum Communis Tendon Transfer for Finger Extension
This chapter details the surgical steps involved in tendon transfer from the flexor carpi radialis (FCR) to the extensor digitorum communis (EDC) to restore finger extension. Tendon is harvested from FCR and transferred subcutaneously around the radial si
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Keith Aldrich Jr. and Harris Gellman
Indications 1. Radial nerve palsy with loss of digital extension, with failure to recover, does not include thumb extension (separate transfer). 2. Usually plan transfer after 6 months to 1 year. 3. Need full passive flexion and extension of digits. 4. Donor muscle should be MRC 4+ to 5.
Essential Steps Preoperative Marking 1 . Palpate the radial artery. 2. Identify the flexor carpi radialis (FCR). 3. Mark a line over the FCR ulnar to the radial artery. 4. With the wrist extended, identify the extensor digitorum communis (EDC).
K. Aldrich Jr., M.D. (*) Department of General Surgery, Division of Plastic Surgery, University of Miami, C.R.B. 4th floor, 1120 NW 14th Street, Miami, FL, USA e-mail: [email protected]; [email protected] H. Gellman, M.D. Orthopedic and Plastic Surgery, University of Miami, C.R.B. 4th floor, 1120 NW 14th Street, Miami, FL, USA e-mail: [email protected]
5. Mark a line over the central distal forearm over the EDC tendons.
Intraoperative Details 1. Patient supine with upper extremity on hand table. Tourniquet on upper arm. Set the tourniquet at 250–265 mmHg. 2. General anesthesia or monitored anesthesia care (MAC). 3. Volar incision distally over flexor carpi radialis (FCR) insertion. 4. Identify and protect radial artery. 5. FCR transected as distally as possible. 6. Dorsal incision made over central, distal forearm. 7. Extensor digitorum communis (EDC) identified. 8. Radial subcutaneous tunnel created and FCR pass to EDC tendons. 9. EDC tendons connected side to side and tensioned to restore normal cascade of digits with pull on tendons proximal to anastomosis. 10. Wrist held in 30° extension and MCP joint in full extension. FCR is secured using a Pulvertaft weave to the EDC tendons proximal to the side-to-side anastomosis with 3-0 Ethibond suture. (This allows easy tensioning of all four fingers.) 11. Tension is adjusted so that with the wrist in neutral, all fingers are at full extension, with
© Springer International Publishing Switzerland 2017 T.A. Tran et al. (eds.), Operative Dictations in Plastic and Reconstructive Surgery, DOI 10.1007/978-3-319-40631-2_128
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K. Aldrich Jr. and H. Gellman
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wrist flexion extension increased, and with wrist extension the fingers close easily. 12. Tourniquet is deflated and hemostasis is achieved. 13. Skin is closed with 4-0 nylon suture. 14. Sugar-tong splint applied extending to fingertips keeping the wrist in 30° of extension and MCP joints fully extended.
Postoperative Care 1 . Patient returns in 2 weeks for suture removal. 2. Can switch to short arm cast, but cast should still keep wrist extended, MCP’s extended, and include fingers to tip of finger. 3. Immobilized for 6 weeks total. 4. Occupational therapy started after 6 weeks to regain motion.
Possible Complications 1. Tendon adhesion 2. Attenuation of transferred tendon
Operative Dictation Diagnosis: Radial nerve injury with loss of digital extension Procedure: FCR to EDC transfer
Indication This is a ________ w
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