Tendon transfer : Prerequisites

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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. 

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