Name of the Procedure:

Repair of Extensor Tendon – Central Slip, Secondary (e.g., Boutonniere Deformity) with Free Graft

Summary

This surgical procedure involves repairing the central slip of the extensor tendon in a finger, typically to correct a deformity known as boutonniere deformity. The surgery includes using a free graft, which is tissue taken from another area of the patient's body to replace or support the damaged tendon.

Purpose

The main goal of this surgery is to repair a damaged extensor tendon in the finger, restoring proper finger extension and function. This procedure corrects deformities that impede normal finger movement, specifically addressing issues like boutonniere deformity where the finger is bent at the middle joint and hyperextended at the tip.

Indications

• Presence of boutonniere deformity.
• Inability to extend the finger properly at the middle joint.
• Chronic pain or functional impairment.
• Unsuccessful outcomes from nonsurgical treatments such as splinting or physical therapy.

Preparation

• Follow any specific instructions provided by your surgeon, including fasting or medication adjustments.
• Undergo necessary diagnostic tests, such as X-rays or MRI, to assess the extent of tendon damage.
• Arrange for transportation home post-surgery, as you will likely be unable to drive.

Procedure Description

1. Anesthesia: The procedure usually begins with the administration of regional or general anesthesia.
2. Incision: A small incision is made over the affected area of the finger.
3. Tendon Preparation: The damaged tendon is identified, and any scar tissue or damaged sections are carefully removed.
4. Harvesting the Graft: A suitable graft is obtained from another part of the patient’s body.
5. Grafting: The harvested graft is placed into position and secured to repair and reinforce the damaged tendon.
6. Closure: The incision is closed with sutures, and the finger may be placed in a splint to stabilize it during healing.

Duration

The procedure typically takes about 1-2 hours, but this can vary based on the complexity of the case.

Setting

The surgery is usually performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic or plastic surgeon specializing in hand surgery.
• Surgical nurse.
• Anesthesiologist or nurse anesthetist.
• Surgical technician.

Risks and Complications

• Infection at the incision site.
• Bleeding or hematoma formation.
• Nerve damage leading to altered sensation.
• Graft rejection or failure.
• Stiffness or loss of motion in the finger.
• Blood clots.

Benefits

• Restoration of normal finger extension and improved hand function.
• Reduction in pain and discomfort.
• Correction of deformity and improved aesthetic appearance.
• Return to normal activity levels.

Recovery

• Follow post-operative care instructions, including keeping the incision clean and dry.
• Attend follow-up appointments for monitoring and suture removal.
• Participate in prescribed physical therapy to restore full function.
• Avoid heavy lifting or strenuous activities with the affected hand for several weeks.
• Complete recovery may take several months, depending on the individual and the extent of the repair.

Alternatives

• Non-surgical options such as splinting, physical therapy, or corticosteroid injections.
• Arthrodesis (joint fusion) for severe deformities.
• Pros of alternatives: Less invasive, lower immediate risks.
• Cons of alternatives: May not provide long-term resolution, decreased functional outcomes compared to surgery.

Patient Experience

• During the procedure, patients will be under anesthesia and should not feel pain.
• Post-surgery, some discomfort, swelling, and stiffness can be expected.
• Pain can be managed with prescribed medications and ice application.
• Adherence to physical therapy is crucial for a successful recovery and restoring full function.