Avanzamiento en Z: una alternativa para reconstrucción de GAP tendinoso en mano
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Fecha
2021
Autores
Arcila Piedrahita, Andrés
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
Las lesiones tendinosas en las que no es posible la realización de tenorrafia termino-terminal representan un reto quirúrgico en cirugía de mano. En la literatura se describen múltiples técnicas entre las que se mencionan: injertos tendinosos, alargamientos tendinosos, transferencias tendinosas, reconstrucción en dos tiempos, entre otras. La reparación tendinosa debe seguir una escala terapéutica de menor a mayor complejidad.
Lo ideal siempre en cualquier caso de lesión tendinosa será la reparación primaria, lo que exige una retracción tendinosa mínima y extremos tendinosos en buenas condiciones.
En los casos en los que esto no es posible como los reportados en el presente artículo, siguiendo la escala terapéutica se debería continuar con la transposición o el injerto tendinoso.
En este artículo describimos una técnica de avanzamiento en “Z” de tendones extensores para reconstrucción de defectos tendinosos a nivel de los dedos y antebrazo, en pacientes con trauma agudo en los cuales la tenorrafia primaria no fue posible. Se realizó el seguimiento postoperatorio obteniendo resultados favorables, con recuperación de la función. Nuestra técnica es fácil de ejecutar, reproducible, requiere un solo acto quirúrgico, así como menor tiempo de este a diferencia de las técnicas descritas en la literatura para reconstrucción de GAP (brecha) tendinoso y representa una menor morbilidad en comparación con otras técnicas de reconstrucción como los injertos tendinosos, evitando la necesidad de tomar áreas donantes.
Tendon injury in which it is not possible to perform primary surgical repair represent a surgical challenge in hand surgery. Multiple techniques are described in the literature, among which are mentioned: tendon grafts, tendon lengthening, tendon transfers, two-stage reconstruction, among others. Tendon repair should follow a therapeutic scale from less to greater complexity. The ideal always in any case of tendon injury will be primary repair, which requires minimal tendon retraction and healthy tendon ends. In cases where this is not possible as reported in this article, following the therapeutic scale, the transposition or tendon graft should be done. This article describes an advance technique in “Z” of extensor tendons for the reconstruction of tendon defects at the level of the fingers and forearm, in patients with acute trauma in which primary surgical repair was not possible. Postoperative follow-up was obtained, obtaining favorable results, with recovery of function. Our technique is easy to execute, reproducible, requires a single surgical act, as well as less time thereof, unlike the techniques described in the literature for the reconstruction of tendon GAP, and represents a lower morbidity compared to other techniques of reconstruction such as tendon grafts, avoiding the need to take specific areas.
Tendon injury in which it is not possible to perform primary surgical repair represent a surgical challenge in hand surgery. Multiple techniques are described in the literature, among which are mentioned: tendon grafts, tendon lengthening, tendon transfers, two-stage reconstruction, among others. Tendon repair should follow a therapeutic scale from less to greater complexity. The ideal always in any case of tendon injury will be primary repair, which requires minimal tendon retraction and healthy tendon ends. In cases where this is not possible as reported in this article, following the therapeutic scale, the transposition or tendon graft should be done. This article describes an advance technique in “Z” of extensor tendons for the reconstruction of tendon defects at the level of the fingers and forearm, in patients with acute trauma in which primary surgical repair was not possible. Postoperative follow-up was obtained, obtaining favorable results, with recovery of function. Our technique is easy to execute, reproducible, requires a single surgical act, as well as less time thereof, unlike the techniques described in the literature for the reconstruction of tendon GAP, and represents a lower morbidity compared to other techniques of reconstruction such as tendon grafts, avoiding the need to take specific areas.
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Palabras clave
Alargamiento tendinoso, Ruptura tendinosa, GAP tendinoso, Avance tendinoso, Mano, Extensor, Tenorrafia, Tendon lengthening, Tendon rupture, Tendon GAP, Tendon advance, Hand, Extensor, Tendonraphy
