Free Autologous Composite Tendon Grafts for Division of Both Flexor Tendons within the Digital Theca of the Hand

¹ University Department of Orthopaedic Surgery, Outram Road General Hospital, Singapore 3

Autologous composite grafts of the entire flexor mechanism obtained from the longest toe and transferred to a finger were observed to survive histologically and be revascularized both in monkeys and in humans, with no adhesions between the tendons and the walls of the grafted tunnel. The synovial lining of the grafted sheath and tendons remained intact, preventing adhesions, and new vessels appeared to reach the tendons through the vinculae. Clinical results in thirteen patients were encouraging despite a flexion deformity of the proximal interphalangeal joint, a constant finding in both monkeys and humans. Although not the final solution of the complex problem of repair of flexor tendons within the digital theca, the results after autologous composite grafts suggest that a physiological method for the restoration of the normally present gliding mechanism of two flexor tendons in a finger may be possible.

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