Two-stage flexor tendon reconstruction in zone II using a silicone rod and a pedicled intrasynovial graft

Purpose: To evaluate the results of a modified Paneva-Holevich technique for flexor tendon reconstruction in zone II. Methods: Twenty patients (22 digits) with poor prognosis injuries (Boyes grade 2-5) were reconstructed. The technique included placing, a silicone rod and creating a loop between the flexor digitorum profundus (FDP) and the flexor digitorum superficialis (FDS) in the first stage and reflecting the latter as a pedicled graft through the pseudosheath created around the silicone rod in the second stage. Results: After a follow-up period of at least 1 year (mean, 50 mo) the rate of good and excellent results was 82% according to the Buck-Gramco scale and 73% using the modified Strickland scale. Conclusions: These results compare favorably with those using the classic (Hunter) 2-stage reconstructions with a silicone rod and a free tendon graft. Apart from technical versatility, additional advantages of the technique include using a local intrasynovial graft, the absence of donor site morbidity, and a low rate of postreconstruction tendon ruptures and tenolysis.