Tendon transfers in hand surgery.

The need for skilled surgeons, trained in the proper techniques of hand surgery, to reconstruct paralytic hands has been emphasized. The most useful techniques for radial nerve paralysis have been found to be transfer of the pronator teres to the extensor carpi radialis brevis, of the flexor carpi ulnaris into the extensor digitorum communis, and of the palmaris longus into a rerouted extensor pollicis longus. For treatment of clawhand, the Bunnell sublimis transplantation is recommended for mild deformities in patients without normally hyperextensible joints and for patients who need a powerful flexor force on the proximal phalanges for strong gripping of tools, such as those used by mechanics and carpenters. The modified Fowler extensor transplant is also recommended for cases detected early and can be used for more advanced cases. The recent Brand procedure, which uses the extensor carpi radialis longus and a four-tailed tendon graft to the palmar side through the carpal tunnel and lumbrical canal, is also recommended, but further experience is needed for full evaluation of this procedure. Of the static methods of overcoming clawed hands, the Zancolli procedure of advancing the palmar plate proximally provides good results, although it probably should be reserved for those patients in whom no active tendon transfer can be provided. Long-term experience has shown that this capsulodesis seems to gradually stretch out and allow some recurrence of the hyperextension of the proximal joint. The Fowler tenodesis, which has an advantage over the Riordan method, is a semiactive tenodesis.(ABSTRACT TRUNCATED AT 250 WORDS)