Two-stage grafting of digital flexor tendons: a review of 43 patients after 3 to 15 years.

We reviewed 9 (3-15) years postoperatively all 43 two-stage flexor tendon transplantations in fingers that had not otherwise been severely injured that we had operated on during the years 1984 to 1996. One digit had been reconstructed in each patient. The interval between the first and second stage operations was 19 (14-51) weeks. Time away from work was 44 (4-140) days after the first procedure and 101 (38-297) days after the second stage operation. After the second stage, 26 further procedures had been done in 18 of the 43 fingers. These included seven resutures of the transplanted tendon (three in the same finger), five tenolyses, two capsulotomies of the proximal interphalangeal (PIP) joint, three arthrodeses of the distal interphalangeal (DIP) joint (two combined with reinsertion of the tendon to the middle phalanx), one DIP + PIP arthrodeses, and three amputations of PIP. One further finger will be amputated and two patients do not wish treatment for ruptured transplants. There were 15 excellent, six good, nine fair, and 12 poor results at review. A total of 31 of the 43 patients said they would have had the operation if they had known the outcome in advance. Reconstruction of a flexor tendon takes a long time and causes many complications. Even so, it is indicated in motivated and fully informed patients because of a lack of other viable options.