Tendon transfer : Prerequisites

-

Prerequisites for tendon transfers:


A) Donor (Tendon) related


 1. Adequate strength of the transferred tendon:

  • →  85% of power is a must (Steindler) -graded as good power.
  • →  “Omer” stated that a muscle loses at least one grade of strength after transfer; so for useful postoperative movement 4/5 power is a must.
2. Amplitude of the transferred tendon should be as near to the original tendon for which the transfer is being done. 

3. Synergism: Synergistic transfers should be preferred as much as possible, however there are a lot of violations of this rule.

4. Expendable donor: there should be no functional morbidity following use of a tendon. 

B) Recipient (site) related


 1. Tissue should be in equilibrium.
  2. →  Soft tissue induration should subside.
  3. →  No reaction in wounds.
  4. →  Joints are supple.
  5. →  Scars should be as soft as possible.
2. Correction of contractures (all joints must be supple).

3. Try to restore sensibility of distal organ before treatment. 

4. Arthrodesis/ joint procedure should be done before tendon transfer.

5. The disorder should be a non-progressive one.

C) Technique related


 1.  One tendon- one function, I.e., flex or extend

 2. Straight line of pull: No pulley is ideal or minimum number of pulleys should be made. 

 3. Pass tendons below fascial planes/ sheaths and not below incision line/scar (best b/n subcutaneous fat and fascial sheath).

 4. Insertion of tendon should be as close to the insertion of paralyzed tendon
  1. →  at the same angle
  2. →  if split transfer, then keep both slips in same tension.
5. Try preserving the nerve and vascular supply to muscle and vascular supply to the tendon. 

6. Keep dissection to a minimum around the muscle to be transferred and achieve meticulous hemostasis to prevent adhesion formation. 

Comments

Post a Comment

Popular posts from this blog

Hanging Cast

-
Image
Indications 1.      For displace fracture of the humeral shaft with shortening, and also for oblique and spiral fractures –(Caldwell, 1933)  2.      Used for comminuted humeral fracture, distal humeral shaft fracture. ·       Cast must be lightweight and must extend from at least 1 inch proximal to the fracture site to wrist, with elbow at right angle & forearm in neutral rotation. ·        Arm must lie dependent to provide a traction force. ·        Patient must sleep erect or semi-erect to avoid supporting elbow when seated. ·        Erect position is maintained during the day as much as possible. ·     There should be no support under the elbow, and nothing should compress the arm against the body (such as clothing). It is frequently exchanged for functional bracing 1 to 2 weeks after injury. Correction Of Angulation: 1.      Sling must be securely fixed at the wrist by a loop made of plaster or other material.      To c
Read more

SOMI Brace

-
Image
Sternal-Occipital-Mandibular Immobiliser  (SOMI) Brace  Cervico-Thoracic Orthoses (CTOs) provide greater motion restriction from C5-C7 spine from the increased leverage on the person’s body. The upper cervical spine has less motion restriction. CTOs are used in minimally unstable fractures . All CTO’s tend to control flexion better than extension . Parts 1. The SOMI is a rigid, 3-poster CTO that has an padded anterior chest plate extending to the xiphoid process, as well as two padded shoulder extension which hook over tops of the shoulder. 2. From these shoulder extension two Straps which cross in the interscapular region, pass downward and around the chest wall to attach to the lower part of the chest plate. 3. There are three adjustable uprights , which pass upward from the chest plate, two to the padded occipital support and one to the mandibular support. 4. A removable chin piece attaches to the chest plate with
Read more

Skeletal Traction: Common sites

-
Image
1. Olecranon Site: 1.25 inches (3 cm) distal to the tip of olecranon just deep to the subcutaneous border of upper end of the ulna. Direction:  Medial to lateral at right angles to the longitudinal axis of ulna. Avoid: Ulnar nerve injury. 2. Second & Third Metacarpals Site:  About 1 inch (2-2.5 cm) Proximal to the distal end of Second metacarpal Direction:  The wire traverses 2nd and 3rd metacarpals transversely at right angles to the longitudinal axis of the radius. 3. Greater trochanter (upper end of femur ) Site: On the latera
Read more