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American Association for Hand Surgery
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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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The Utility of Composite Flexor Tendon Allograft Subunits for Digital Pulley System Reconstruction
Anthony J Archual, MD1; Brent R DeGeorge, MD, PhD1; David B. Drake, MD2; (1)University of Virginia, Charlottesville, VA, (2)Plastic Surgery Department, University of Virginia, Charlottesville, VA

PURPOSE: Optimal gliding function of the digital flexor mechanism relies on a competent pulley system, which may be injured through traumatic, infectious, or iatrogenic etiologies.  Restoration of the digital pulley mechanism is paramount to achieving optimal tendon gliding without bowstringing or adhesion formation, but current methodology for pulley reconstruction involves a myriad of tendon graft techniques that are non-anatomic and technically demanding. We have therefore devised a novel technique for pulley reconstruction using the pulley components of composite flexor tendon allograft (CTFAs).

Methods: A 5 year retrospective review of a prospectively maintained institutional database of all patients undergoing reconstruction of the digital pulley system utilizing the A2 and / or A4 pulley subunits of sterile, acellularized, composite flexor tendon allografts (CFTAs) between 2012 and 2016.  Demographic information, nature of pulley incompetence, range of motion, grip strength, and disability of the arm, shoulder, and hand (DASH) scores were reviewed.  Biomaterials testing of the processed A2 and A4 pulley subunits, including tensile strength, gliding resistance, and ultrastructural architecture was investigated.      

Results: Four A2 and two A4 pulley reconstructions were performed on five patients.  Average total length of follow-up was 12.8 months.  Average disability of the shoulder, arm, and hand scores were significantly improved from a pre-operative mean of 32.9±8.6 to a post-operative mean of 2.9±0.6.  Total active digital range of motion was significantly improved from a pre-operative mean of 112.8±9.1 to a post-operative mean of 197.0±7.5.  No instances of surgical site infection, tendon adhesions, pulley incompetence, triggering, re-operation, or removal of allograft were encountered. 

Conclusions: Reconstruction of pulley system deficits using the A2 or A4 components of CFTAs allows for anatomic replacement of “like with like” without additional donor site morbidity or technically demanding tendon weave constructs. 


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