Evaluation of the outcomes of bypass tendon transfer to finger flexors by tensor fascia lata graft in patients with Volkmann's contracture

Abstract

Volkmann’s ischemic is a condition involving muscle ischemia and necrosis that subsequently led to fibrosis and contracture of the forearm. . Volkmann’s ischemic is the result of an acute compartment syndrome. Immediate identification of the compartment syndrome and its early treatment is mandatory to avoid its devastating consequences, such as Volkmann’s ischemic contracture. Once the contracture sets in, the prognosis is poor, even after long and intensive physiotherapy and various restorative surgical techniques. ischemic contractures are classified according to the severity of involvement and Treatment depends on the severity of the contracture. Various treatment options have been mentioned in the literature, ranging from splinting and passive stretching to osteotomy, excision of fibrotic tissue, neurolysis, tendon transfer, and free functional muscle grafts. Free muscle transfer in Volkmann's contracture surgery is the most difficult method to achieve good results. The aim of the present study was to evaluate the outcomes of bypass tendon transfer to the finger flexors by tensor fascia lata graft in patients with Volkmann's contracture. Materials and Methods: This non-randomized clinical trial was conducted on 15 patients (based on a relevant study - census sampling) during 2015-2019 in Emamreza Hospital (Tabriz). The patients underwent surgery in two stages. In the first stage, muscle release and nerve neurolysis were done, and in the second stage, the tendon was prepared and connected to the bypass in the volar forearm at the proximal and to the finger flexors at the distal joint. Hand grip strength, finger and wrist range of motion, hand dexterity, and daily activities were assessed using the considered tools and the data were compared using SPSS 20. P <0.05 was considered significant. Results: The preoperative status of the subjects regarding the studied variables was very unfavorable, however after surgery hand grip strength (81.35±10.18), Fugl-Meyer (29.49±05.25) hand dexterity (08.59±01.83), and daily activities (81.10±07.43) showed a very favorable and significant improvement (P = 0.001).