title: Z-plasty lengthening of the flexor digitorum profundus at the wrist (zone 5) for the treatment of jersey finger: anatomical study and evaluation of advancement obtained.
abstract: OBJECTIVE
  The aim of this study was to conduct an anatomical evaluation of advancement obtained from Z-plasty lengthening of the flexor digitorum profundus at the wrist (zone 5) for the treatment of jersey finger.
  
  
  BACKGROUND
  The avulsion of the flexor digitorum profundus from its distal insertion, or jersey finger, is an injury commonly missed in the accident and emergency department. Typically, after 3 weeks, the retracted tendon stump prevents direct reinsertion of the tendon. Sawaya et al. have proposed a treatment involving a zone 5 Z-plasty lengthening on the fourth finger. We conducted an anatomical study to evaluate the tendon advancement that could be obtained in the long digits using this method.
  
  
  METHODS
  Tendon avulsion was recreated in 17 fresh cadaver hands by severing the flexor digitorum profundus from its distal insertion. A 3-, 4- or 5-cm Z-plasty was performed at the wrist and, after section of the vinculum breve, the advancement was measured with wrist extension at 0°.
  
  
  RESULTS
  A total of 68 tendon reconstructions were performed. The mean advancement obtained was 1.5 cm (max: 2.5 cm; min: 0.5 cm), 2.3 cm (max: 3.2 cm; min: 1.3 cm) and 2.5 cm (max: 3.5 cm; min: 1.7 cm) for 3-, 4- and 5-cm Z-plasties, respectively. Tendon advancement in the ring finger and middle finger was limited by the lumbrical (2 cases) or by synovial adhesions in the carpal tunnel (16 cases). There was no such limitation for the index finger.
  
  
  CONCLUSIONS
  Advancement of the flexor digitorum profundus by a 4-cm Z-plasty at the wrist seems to be a useful technique for reinsertion of a retracted tendon. The best results were obtained in the index finger. This technique could be considered as an alternative to palliative surgery or a tendon graft. In the other fingers, the fact that advancement was limited due to Verdan's quadriga effect and synovial adhesions highlights the significance of the relationship between the tendons themselves and with their environment on the physiology of finger flexion.
authors.affiliation: Plastic Surgery, Reconstruction and Burns Unit, Rangueil University Hopsital Centre, 1 Avenue du Pr Jean Poulhès, TSA 31059 Toulouse Cedex, France. Electronic address: lchanel@hotmail.fr.
authors.forename: L
authors.initials: L
authors.lastname: Chanel
authors.affiliation: Plastic Surgery, Reconstruction and Burns Unit, Rangueil University Hopsital Centre, 1 Avenue du Pr Jean Poulhès, TSA 31059 Toulouse Cedex, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Grolleau
authors.affiliation: Rangueil Anatomy Laboratory, Toulouse-Rangueil Toulouse Medical Faculty, 133 route de Narbonne, 31063 Toulouse, France.
authors.forename: F
authors.initials: F
authors.lastname: Lauwers
authors.affiliation: Plastic Surgery, Reconstruction and Burns Unit, Rangueil University Hopsital Centre, 1 Avenue du Pr Jean Poulhès, TSA 31059 Toulouse Cedex, France; Rangueil Anatomy Laboratory, Toulouse-Rangueil Toulouse Medical Faculty, 133 route de Narbonne, 31063 Toulouse, France.
authors.forename: A
authors.initials: A
authors.lastname: André
mesh_terms: D002102:Cadaver; D005383:Finger Injuries / Q000145:classification / Q000601:surgery*; D006801:Humans; D019637:Orthopedic Procedures / Q000379:methods*; D013708:Tendon Injuries / Q000145:classification / Q000601:surgery*; D013710:Tendons / Q000033:anatomy & histology / Q000601:surgery*
keywords: Anatomical study; Jersey finger; Lengthening; Tendinoplasty; Z-step