Tendon transfers in muscle and tendon loss.

Tendon transfers in muscle and tendon loss offer some of the most gratifying results to both patient and surgeon. Poor results do occur at times in tendon transfer. When patients whose results were found to be less than expected were studied, the following problems were identified: 1. Acceptance of less than full passive range of motion before transfer. In some instances, this will be unavoidable. The use of pretransfer hand therapy techniques may improve the situation; or, if possible, pretransfer capsulotomies may better prepare the patient for the tendon transfer. 2. Adhesions along the course of the transfer. At times the transfer route can be better prepared by the use of skin grafts adding subcutaneous tissue to the transfer bed. The use of a staged technique in which a silicone rubber tendon implant is installed along the transfer route, to prepare for a later transfer, is occasionally indicated. 3. Technical failures: a. juncture breakdown, b. transfer put in under too little tension. 4. Patient noncompliance. A recent experience in which a patient removed his postoperative cast and came in 2 weeks later with his transfer disrupted is an extreme example. Many other patients are not prepared to undertake what may be a rigorous and time-consuming postoperative transfer program. Adequate preoperative evaluation, including patient selection as well as careful attention to the details of the procedure during surgery, along with attentive postoperative care, should eliminate most of these problems.