A study of 1000 consecutive grafts of flexor tendons in the fingers and thumbs has allowed us to develop a consistent technique and a system of evaluation. The first 300 were reported previously. Detailed analysis of the last 700 grafts, 607 in the fingers and ninety-three in the thumb, permits the following conclusions.
Scarring from injury or additional scarring from inept previous surgery, or failed primary reparative procedures, compromised the results of secondary tendon grafting.
Fingers in which joints had been damaged or in which the interphalangeal joints had become stiffened from neglect did not respond well to tendon grafting, even though the joints were mobilized well before surgery.
In fingers with minimum scarring and only one nerve injured, the results were not impaired, but fingers with both nerves damaged had much less motion.
The level of tendon injury, whether in the proximal, middle, or distal portion of no-man's land was not a determining factor on the result, nor was the time from injury to operation.
Injury of the tendons in more than one digit in itself was not important. The condition of the individual digit determined the outcome for each finger.
Other things being equal, patients over forty years of age did not obtain as much motion from tendon grafts as did the patients in younger age groups.
The palmaris longus tendon was the best donor tendon, but there was little difference noted when a good superficialis tendon was used. The superficialis of the littie finger and the plantaris tendons are not recommended because of their small size and tendency to rupture.
Pulley reconstruction done at the same time as the tendon grafting does not compromise the result.
Loss of a few degrees of extension of the interphalangeal joints is not detrimental, but if the total loss of the two joints exceeds 40 degrees in the index or long fingers and 60 degrees in the ring or little fingers, the limitation of extension is significant.
When a graft separates at the palmar junction or at its insertion, prompt resuture will salvage at least one-half of the digits.
In flexor-tendon grafting in the thumb, the source of the donor tendon, the site of injury, and the presence of considerable scar do not affect the result adversely. The degree of nerve damage had only a minor effect on the result. Grafts extending from the musculotendinous juncture to the terminal phalanx gave better results than the shorter ones.
Fingers treated by primary wound closure and insertion of a tendon graft as a secondary procedure had significantly better results than those treated by grafting after an attempted primary tendon repair had failed.