Experimental STUDY OF OPTIMAL LOCATION OF FLEXOR TENDON PULLEYS

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Abstract
A reconstructive operation involving the flexor tendons in the fingers usually requires dissection of the fibro-ligamentous tunnel in which the tendons lie. In such procedures, the surgeon removes enough of the fibrous tunnel to give satisfactory access and the least chance of postoperative adhesions, but also preserves enough to provide pulleys which prevent the tendon from bow-stringing. Less commonly, following infection or an unsuccessful tendon graft, there is such extensive scarring that none of the fibrous tunnel can be preserved; and it then becomes necessary to construct new pulleys, using free tendon grafts,1, 2 one-half of the sublimis insertion,3 or strips of fascia lata.4 Such pulley reconstruction can be done at the time of the primary surgery, or as a separate and later procedure.5 This paper reports an experimental study, using fresh cadavers, to determine the minimum number and the optimum position of retained or reconstructed pulleys to prevent bow-stringing.

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