Arch Hand Microsurg.  2023 Mar;28(1):24-32. 10.12790/ahm.22.0037.

Modified Pulvertaft orthogonal passing-through suture technique: a preliminary study

• Kim MB
• Jung SY
• Sung DH

• KMID: 2540027
• DOI: http://doi.org/10.12790/ahm.22.0037

Abstract

Purpose
If the primary suture is difficult due to the large size of a tendon defect, reconstruction of the defective tendon is attempted through tendon transfer or tendon graft. The Pulvertaft technique is most commonly used, but it increases bulk and friction, and it could cause adhesion formation. In order to overcome these problems, we aimed to introduce a new technique.
Methods
We retrospectively reviewed 22 patients who underwent tendon reconstruction using the modified Pulvertaft technique due to tendon defects from January 2016 to December 2021. An abbreviated version of the original DASH (Disabilities of Arm, Shoulder and Hand) outcome measure (QuickDASH) was measured 3 months after surgery. Until the final follow-up observation, tendon rerupture, infection, tendon-related complications (quadriga effect, motion limitation due to bulky size of the suture site), and contracture were measured. QuickDASH was compared according to the cause of the tendon defect and the type of operation using the Mann-Whitney test.
Results
The mean QuickDASH score measured 3 months after surgery was 10.42±7.83. No statistically significant difference in the QuickDASH score was found between patients who underwent tendon transfer and those who underwent tendon grafts (p=0.988). Rerupture occurred in 1 case, and there were no cases of infection, tendon-related complications (quadriga effect, motion limitation due to bulky size of the suture site), or contracture.
Conclusion
The orthogonal passing-through suture technique could be a new alternative to the tendon reconstruction technique.

Keyword

Sutures; Tendon reconstruction; Tendon defect; Pulvertaft technique; 봉합; 힘줄 재건; 힘줄 결손; Pulvertaft 봉합법

Figure

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  Fig. 1. (A) Conventional Pulvertaft method. (B) The blue and red tendons are connected by the modified orthogonal passing-through Pulveraft suture method.

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  Fig. 2. (A) Residual portion of the proximal and distal end of the ruptured extensor pollicis longus. (B) Harvesting slip of the abductor pollicis longus (APL) for donor graft. (C) Harvested tendon slip of the APL. (D) Pulvertaft suture between the donor graft and proximal stump. (E) Pulvertaft suture between the donor graft and distal stump. (F) Image of the completed tendon graft. (G) Measuring the tensile strength of tendon graft using a suspension scale.

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  Fig. 3. (A) Ruptured proximal end of the extensor pollicis longus (EPL). (B) Harvesting a slip of the abductor pollicis longus tendon for tendon transfer. (C) Creating a hole for passage of the first Pulvertaft suture. (D) The second Pulvertaft suture. (E) The third Pulvertaft suture. (F) The fourth Pulvertaft suture. (G) Test of sufficient tension for resistance. (H) Completed EPL reconstruction using the Pulvertaft suture.

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  Fig. 4. (A) Proximal end of the ruptured extensor pollicis longus (EPL). (B) Wide gap between both ruptured ends of the EPL, making direct repair impossible. (C) Harvesting a slip of the extensor carpi radialis brevis by longitudinal cleavage for the donor tendon. (D) Approximation of the proximal and distal ends of the ruptured EPL and donor tendon. (E) Suture between the proximal end of EPL and the graft tendon using the Pulvertaft method. (F) Suture between the distal end of the EPL and the graft tendon using the Pulvertaft method. (G) The third suture between the ruptured EPL and the graft tendon using the orthogonal Pulvertaft method. (H) Completed EPL reconstruction using a Pulvertaft suture (the fourth suture).

Reference

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