title: Braun's flexor tendons transfer in disabled hands by central nervous system lesions.
abstract: BACKGROUND
  Since Braun's article, the nonfunctional hand of brain-injured patients has not been the subject of many publications. The objective of surgical treatment is to open the hand for hygiene and cosmetic reasons. The technique consists in lengthening the extrinsic flexor tendons group.
  
  
  OBJECTIVE
  The purpose of this work is to assess eventual functional benefits from superficialis-to-profundus tendon transfer according to Braun.
  
  
  METHODS
  Our series comprised 15 patients aged a mean 55 years, operated using the Braun procedure for a nonfunctional hand (19 hands). Additional procedures were performed as required by the local condition (neurotomy of the deep branch of the ulnar nerve, wrist fusion, tenotomy of the flexors of the wrist and flexor pollicis longus, tenodesis of the extensors of the wrist). The results were assessed by the analysis of finger opening ability and by a specific scoring system (Mini Hand Score; MHS) rated from 6 (no discomfort) at 20 (major discomfort).
  
  
  RESULTS
  The mean follow-up was 6 months. We observed imperfect results: thumb opening incapacity, spasticity of the intrinsic flexors, and hyperextension of the wrist. The preoperative MHS was a mean 13.87 out of 20 and the postoperative MHS was 9.67 out of 20, with a very substantial difference.
  
  
  CONCLUSIONS
  Our easy-to-use system for evaluating the nonfunctional hand (MHS) was shown to be very effective in demonstrating the improvement of the postoperative result. The originality of our series was to show that Braun's original operation goals were only exceptionally and remotely achieved and that an additional technical procedure must be nearly systematically considered. All the patients in our series were followed up in multidisciplinary team visits where the patient's family and caretakers were encouraged to give their point of view. Level of evidence Level IV. Retrospective study.
authors.affiliation: SOS Hand, Orthopaedic and Hand Surgical Unit, Strasbourg University Hospitals, 10, avenue Achille-Baumann, 67403 Illkirch cedex, France.
authors.forename: Sybille
authors.initials: S
authors.lastname: Facca
authors.forename: Pascal
authors.initials: P
authors.lastname: Louis
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Isner
authors.forename: Dominique
authors.initials: D
authors.lastname: Gault
authors.forename: Yves
authors.initials: Y
authors.lastname: Allieu
authors.forename: Philippe
authors.initials: P
authors.lastname: Liverneaux
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001925:Brain Damage, Chronic / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology*; D009128:Muscle Spasticity / Q000601:surgery*; D012086:Reoperation; D020521:Stroke / Q000150:complications / Q000601:surgery*; D013709:Tendon Transfer / Q000379:methods*; D058971:Tenotomy / Q000379:methods*; D013933:Thumb / Q000601:surgery