Tenolysis in Zones IV and V (Tamai) Replantation

Abstract

The range of movement of replanted fingers in Tamai's zone IV or V may not always be satisfactory due to joint stiffness or tendon adhesion around the replantation site. Here, we describe the results of tenolysis in 17 replantations over a 10-year period. Fifteen replantations involved partial amputation of more than two digits, and two involved injury of one digit. The level of amputation included 14 digits in zone IV and three digits in zone V. Initial tenolysis was carried out at an average of 9 months after replantation. Flexor tenolysis was conducted in 14 digits and extensor tenolysis combined with a pedicled fat flap in three. Overall, the total range of active motion (TAM) averaged 87° (range, 40° to 180°). According to Yoshizu's assessment, 10% recovery of TAM was achieved by flexor tenolysis and 15% by extensor tenolysis. Since this series included many multiple digital amputations, we evaluated flexor tenolysis as unfavorable. Our findings suggest that an adipofascial flap underneath the extensor tendon is conducive for extensor tenolysis in replanted digital units.