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Hand - Tendon Transfers

Robert S. Boome

Consultant Hand & Peripheral Nerve Surgeon, Bradford Royal Infirmary

Tendon transfers are done as soon as it is considered that no further nerve recovery can take place and that the function of the hand is insufficient for normal use. The transfers are always assessed at two or three visits from the patient in which all the functioning motors are listed. The transfers needed are listed and compared to establish which is the best combination for this particular patient. Numerous complex problems eg. one of median and ulna major compromised - but still the function of the hand can be significantly improved if care is taken in making the right selection.

There are no absolute contra-indications to any particular tendon transfers, excepting for the extensor carpi radialis brevis, which should never be used for transfer as it is the major wrist extensor and, if it is working well, all the other wrist extenscors can rather be sacrificed but this one should be maintained.

The technique of tendon transfers for major nerve injuries in the forearm is, in principle, the careful assessment of the recovery from injury to the point that no further recovery is expected.

Or, if the injury is such that no recovery is expected from the beginning, then tendon transfers can be done early.

In each case the available tendons must be carefully examined and a decision made as to whether they can be sacrificed for transfer to another function and to match to a list of major functions needed by the patient and planned as such.

My own experience is that median and ulnar nerves repair well at the wrist with a modified epineural repair - separating motor from sensory to make accurate repair of each nerve gives excellent recovery of intrinsic function in young individuals to the point that it is seldom necessary to do, intrinsic transfers within the hand.

Even medial and ulnar nerves repaired in the acute phase at the proximal forearm may well achieve intrinsic recoveries to some degree and therefore enough time should be allowed before tendon transfers are performed in order to assess what recovery might take place.

With all nerve injuries treated acutely, I avoid trimming of the nerve at all, excepting in crush injuries as any amount of trimming compromises the alignment of your fine fibres therefore compromises your end result.

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