Delayed reconstruction of a missed Extensor Pollicis Brevis and Abductor Pollicis Longus injury using tendon transfers and an onlay tendon graft: a case report

Orthoplastic Surgery Pub Date : 2022-09-01 DOI:10.1016/j.orthop.2022.05.003

Tobias J. Bos , Ton A.R. Schreuders , Berbel J.R. Sluijter , Miriam C.J. De With

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Abstract

Delayed presentation of extensor tendon injury comes with unique challenges due to retraction of tendons, adhesions and problems of disuse of the muscles. We present a case report of tendon reconstruction eight months after a sharp injury to the Extensor Pollicis Brevis (EPB) and Abductor Pollicis Longus (APL) tendon in zone VIII. The EPB was reconstructed by using an Extensor Indicis Proprius (EIP) to EPB transfer. The APL was found slack due to a large section of pseudotendon. After tenolysis the proximal tendon stump of the EPB was sutured to the APL, thus combining the impaired EPB and APL muscles for APL function. The slack section of pseudotendon of the APL was plicated to restore tension and reinforced with an onlay tendon graft (left-over from the EIP transfer). Outcomes were excellent. This is the first publication to discuss delayed repair of a combined EPB and APL injury and gives insights into the anatomical and biomechanical balance of the thumb extensors.

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延迟重建拇短伸肌和拇长外展肌损伤的肌腱转移和覆盖肌腱移植物:1例报告

伸肌腱损伤的延迟表现具有独特的挑战，因为肌腱的回缩，粘连和肌肉的废用问题。我们报告一例在VIII区拇短伸肌(EPB)和拇长外展肌(APL)肌腱尖锐损伤八个月后进行肌腱重建的病例。利用食指固有伸肌(EIP)向EPB转移重建EPB。由于大面积假肌腱，APL松弛。肌腱松解后，将EPB近端肌腱残端与APL缝合，将受损的EPB与APL肌肉结合，实现APL功能。将APL假肌腱松弛部分进行折叠以恢复张力，并用附着肌腱移植物(EIP转移后的剩余部分)进行加固。结果非常好。这是首次讨论EPB和APL合并损伤的延迟修复的出版物，并对拇指伸肌的解剖和生物力学平衡提供了见解。

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