Kyle J. Chepla, MD
Division of Plastic Surgery at MetroHealth Medical Center, Cleveland, Ohio; Associate Professor of Surgery at Case Western Reserve University School of Medicine. Dr. Chepla’s special interests include surgery of the hand and wrist, peripheral nerve surgery, upper extremity reconstruction, and surgical treatment of tetraplegia.
Background
Tendon transfers are widely utilized reconstructive procedures following peripheral nerve injury, central neurologic deficit (e.g., stroke, cerebral palsy, or spinal cord injury), and attritional tendon rupture. The primary indications include restoration of absent function or restoration of functional balance to optimize use of the affected extremity. When appropriate preoperative conditions are met, outcomes are both reproducible and predictable. These conditions include supple joints with full passive range of motion, stable soft tissue coverage, availability of an expendable synergistic donor with adequate strength and excursion, a straight line of pull, and the assignment of a single function per transfer. Optimal results also depend on ensuring adequate transfer strength to tolerate early active postoperative mobilization, combined with comprehensive occupational therapy for patient education, splint fabrication, and adherence to a structured home exercise program.
Proper tensioning of the tendon transfer is critical for success. This is typically done intraoperatively through a combination of tenodesis effect, standardized joint positioning, and simulated contraction by applying direct traction to the donor tendon. Inadequate tensioning is one of the most common causes of revision surgery. Transfers set too loosely may fail to generate sufficient excursion or force to provide meaningful function, while overly tight transfers can restrict antagonist movement or limit motion at adjacent joints.
In select cases, tendon transfers can be performed under wide-awake local anesthesia, with or without tourniquet control, allowing real-time assessment of transfer tension and function. When wide-awake surgery is not feasible, use of CHECKPOINT GUARDIAN® may be used to simulate donor muscle contraction, offering an additional method to verify appropriate tensioning.
Click the link above to download the full technique guide.
CS-9095-MKT-027-A
References
- Omer GE Jr., Vogel JA. Determination of Physiological Length of a Reconstructed Muscle-Tendon Unit through Muscle Stimulation. J Bone Joint Surg Am. 1965;47:304-312.
- Har-Shai Y, Gil T, Metanes I, Labbé D. Intraoperative muscle electrical stimulation for accurate positioning of the temporalis muscle tendon during dynamic, one-stage lengthening temporalis myoplasty for facial and lip reanimation. Plast Reconstr Surg. 2010;126(1):118-125.
Please note: Case reports and white papers are company funded and not peer reviewed.
