Surgical outcome of one-stage and two-stage flexor tendon grafting in children.
BACKGROUND
Flexor tendon grafting represents the most common modality for secondary restoration of flexor tendon function. Tendon grafting is either performed in 1 or 2 stages. This study attempts to evaluate the clinical outcome of 1-stage and 2-stage grafting in children.


METHODS
A retrospective review was performed identifying 20 children treated for secondary rupture of the flexor digitorum longus by means of a tendon graft. There were 17 boys and 3 girls with a mean age of 10.8 years (range: 3 to 15) at the time of surgery. The preoperative condition of each operated finger was graded by the digital damage classification recommended by Merle and Dautel. Functional status was obtained throughout follow-up using the Strickland classification.


RESULTS
There were 10 children in grade 1, 6 grade 2, and 4 grade 3 according to Merle and Dautel classification. The delay between the initial trauma or primary procedure and the secondary surgical procedure averaged 7.5 months for 1-stage grafting and 9 months for 2-stage grafting (range: 1 mo to 2 y). The median Strickland index was 70 (range: 55 to 114) for 1-stage grafting and 66 (range 0 to 103) for 2-stage grafting, which was not statistically different (P=0.1).


CONCLUSIONS
The functional outcome seems to depend on the initial severity index. One-stage grafting is a relevant procedure when pulleys are intact and the range of motion is complete. When neurovascular bundles are injured a 1-stage grafting should not be tempted. Satisfactory results are expected with 2-stage grafting providing the principles of this procedure are carefully adhered to.


METHODS
Level 4.
Courvoisier
Aurélien
A
Grenoble University Hospital, Department of Hand Surgery, Grenoble, Cedex, France. acourvoisier@chu-grenoble.fr
Pradel
Philippe
P
Dautel
Gilles
G
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012421:Rupture / Q000601:surgery; D018709:Statistics, Nonparametric; D013708:Tendon Injuries / Q000601:surgery*; D013709:Tendon Transfer / Q000379:methods*; D016896:Treatment Outcome