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Loh et al. Plast Aesthet Res 2017;4:135-6 Plastic and
DOI: 10.20517/2347-9264.2017.43
Aesthetic Research

www.parjournal.net
Letter to Editor Open Access
Tips and tricks for getting more out of your

delayed primary repair of ruptured flexor

pollicis longus tendon

Charles Yuen Yung Loh, Alethea Tan, Makarand Tare
St Andrew's Centre for Plastic and Reconstructive Surgery, Broomfield Hospital, Chelmsford CM1 7ET, UK.
Correspondence to: Dr. Charles Yuen Yung Loh, St Andrew's Centre for Plastic and Reconstructive Surgery, Broomfield Hospital, Chelmsford
CM1 7ET, UK. E-mail: chloh_yy@hotmail.com
How to cite this article: Loh CYY, Tan A, Tare M. Tips and tricks for getting more out of your delayed primary repair of ruptured flexor pollicis longus
tendon. Plast Aesthet Res 2017;4:135-6.

Article history: Received: 08-06-2017 Accepted: 20-07-2017 Published: 25-08-2017

Sir, end had retracted to the wrist.
Primary tendon repairs are often difficult in patients
with delayed presentation. Tendons are contracted and Our tips and tricks used were as follows:
shortened with extensive scarring occurring along the 1. Use of a size 6 feeding catheter attached to a saline-
path of the tendon. Pulleys and the wound bed can filled syringe for hydrodissection of the path. Palpation
be filled with granulation tissue which obstructs the of the catheter through the skin can be performed to
passage of the tendon. Many of such patients would allow localisation of path.
then be treated with a two stage tendon reconstruction, 2. Adequate debridement of granulation and scar
which involves the insertion of a silicone rod for tissue was performed along the path of the tendon,
pseudosheath formation before tendon grafting at especially under the pulleys of the thumb. Pulleys were
[1]
a second stage. This however, would set the patient also stretched using a fine tooth artery clip for several
back for roughly six months, especially involving seconds, which avoided any venting.
multiple visits to physiotherapy and being off work.
We would like to describe several tips and tricks in our 3. The FPL tendon found at the wrist level was delivered
armamentarium and illustrate these using a case we through a wrist incision and stretched under tension for
recently encountered [Figure 1]. 2 min using an artery clip. Le Viet’s releasing incisions
can be performed at the tendon-muscle belly junction
A 40-year-old mechanic presented with a 5-week- for added length if required. [2]
old rupture of the flexor pollicis longus (FPL) at the 4. When attaching the FPL tendon to the feeding
interphalangeal joint (IPJ) of the left thumb. A plan catheter, a gap is left when suturing the two together.
for a two-stage reconstruction of the tendon was Careful retraction of the feeding catheter with the
discussed with him and was scheduled for a silicone tendon is then performed.
rod insertion. Bruner incisions to zone 3 were made 5. A combination of a two strand modified Kessler
and the distal end of FPL was seen but the proximal core suture and a mattress suture was used with a 3/0

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