Opposition Transfer FDS

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TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Execute surgical walkthrough

  • resident to repeat steps to the attending verbally prior to the beginning of the case
  • describe the potential complications and steps to avoid them
F

Room Preparation

1

Surgical instrumentation

  • Loupes recommended

2

Room setup and equipment

  • standard OR table with a hand table

3

Patient positioning

  • place in supine position with shoulder abducted and hand on hand table
G

Superficial Dissection

1

Identify landmarks and draw incision.

  • make a palmar skin incision over the first annular pulley of the ring finger

2

Identify the A1 pulley

3

Incise A1 pulley longitudinally

  • this isolates the FDS tendons
H

Isolate the FDS

1

Divide the FDS tendon

  • apply traction to the FDS to flex the PIP joint
  • divide the FDS transversely
  • do this 4 cm proximal to its bifurcation while protecting the FDP tendon
I

Isolate the FCU

1

Expose the FCU tendon

  • make a zigzag incision over the volar ulnar distal forearm in the region of the FCU tendon insertion

2

Isolate the FCU and the ring finger FDS tendons

  • protect the ulnar neurovascular bundle

3

Divide the FCU tendon

  • transversely cut the radial half of the FCU tendon about 4 cm proximal to its insertion on the pisiform
  • separate the radial half of the tendon longitudinally from the other half
  • this creates a distally-based strip of tendon graft
J

Create Pulley

1

Loop the tendon graft distally

  • pass it through the distal portion of the FCU near the pisiform insertion

2

Pass the FDS tendon

  • pull the cut ring finger FDS tendons into the volar ulnar forearm incision
  • pass it through the constructed pulley
K

Create Tunnel

1

Expose thumb MCP joint

  • make an incision on the radial aspect of the thumb MCP joint

2

Create a subcutaneous tunnel between this incision and the wrist incision

3

Pass the ring FDS tendons through this tunnel to the thumb incision

L

Suture Tendon

1

Align digits

  • place the thumb into opposition with the small finger

2

Suture tendon

  • suture the FDS tendons to the thumb with a 3-0 or 4-0 braided polyester suture
  • The attachment site usually include the abductor tendon plus or minus the dorsal capsule and extensor pollicis brevis tendon
N

Wound Closure

1

Irrigation, hemostasis, and drain

  • copiously irrigate both incisions

2

Superficial closure

  • use 3-0 nylon for closure

3

Dressing and immediate immobilization

  • place a bulky dressing and short arm plaster cast with the wrist in flexion and the thumb in full opposition
Postoperative Patient Care
 

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