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Musculus flexor digitorum profundus aksesuar başı tendonunun alternatif greft olarak kullanılabilirliğinin araştırılması

Year 2022, Volume: 15 Issue: 2, 263 - 272, 31.08.2022
https://doi.org/10.26559/mersinsbd.1114923

Abstract

Amaç: Son yıllarda, artan cerrahi rekonstüksiyon teknikleri ile tendon transferleri sık yapılan operasyonlardan biri haline gelmiştir. Trafik kazaları, kesici alet yaralanmaları ya da bazı romatizmal hastalıkların yarattığı dejeneratif hasarlar sonucunda tendon grefti uygulamaları bir gereklilik haline gelmiştir. Literatürde en çok kullanılan tendon greft donörleri musculus palmaris longus, musculus plantaris, musculus extensor digitorum longus, musculus extensor indicis ve musculus gracilis olarak geçmektedir. Birçok tendon greft donörü olmasına rağmen, farklı kullanım alanları ve varyatif durumlar nedeni ile zaman zaman da alternatif tendon greft donörlerine ihtiyaç duyulmaktadır. Biz de buradan yola çıkarak musculus flexor digitorum profundus aksesuar başının tendon grefti olarak kullanılabilirliğini araştırmayı hedefledik. Yöntem: Çalışmamızda, musculus flexor digitorum profundus aksesuar başı tendonunun, tendon grefti için donör olup olamayacağı iki basamakta incelendi. Birinci aşamada morfometrik olarak uygunluğu, ikinci aşamada ise biyomekanik olarak uygunluğu test edilerek güncel olarak kullanılan musculus palmaris longus ve musculus plantaris tendonlarıyla karşılaştırıldı. Bu amaçla musculus palmaris longus, musculus plantaris ve musculus flexor digitorum profundus aksesuar başının tendonları kullanıldı. Erişkin 11 kadavradan alınan kasların ve tendonlarının uzunlukları, kalınlıkları ve genişlikleri ölçüldü. Elde edilen parametreler birbirleriyle karşılaştırıldı. Alındıkları ekstremitelerin de uzunluk ve genişlikleri ölçülerek, tendonlarla aralarındaki korelâsyonlara bakıldı. Germe test cihazı kullanılarak; maksimum kopma kuvveti, maksimum deformasyon, tendon kopuncaya kadar depolanan enerji, sertlik, maksimum stres, maksimum strain, esneklik katsayısı ve dayanıklılık parametreleri ölçülüp, tendonların biyomekanik özellikleri değerlendirildi. Bulgular: Yapılan analizler sonucunda; hem morfometrik verilerde hem biyomekanik verilerde benzerlikler elde edildi. Sonuç: Sonuç olarak ele alınan aksesuar tendonun morfometrik olarak uygun olduğu, biyomekanik olarak kısmen yeterli olduğu sonucuna varıldı.

Supporting Institution

Mersin Üniversitesi Bilimsel Araştırmalar Projeleri Birimi

Project Number

BAP-SBE TTB (YG) 2013-4 YL

References

  • Alagoz MS, Uysal AC, Tuccar E, Tekdemir I. Morphologic assessment of the tendon graft donor sites: palmaris longus, plantaris, tensor fascia lata. The Journal Of Craniofacial Surgery. 2008;19(1): 246-250.
  • Rosas S, Mesa C, Mesa F. The abductor pollicis longus tendon as an alternative graft in hand surgery. J Hand Surg Am. 2017; 42(3):205-208.
  • Al-Qattan MM, Mohrij SAA. A modified technique of two-staged extensor tendon reconstruction in zones 6–8 in a patient with absent palmaris/plantaris tendons: A case report. Int J Surg Case Rep. 2019;55:99-102.
  • Park DH, Gill IR, Solan MC. Flexor digitorum longus tendon harvest length utilising a limited operative exposure: A cadaveric study. Foot and Ankle Surgery. 2013; 19(1):53–55.
  • Thompson NW, Mockford BJ, Cran GW. Absence of the palmaris longus muscle: a population study. The Ulster Medical Journal. 2001;70(1): 22-24.
  • Lo IN, Yin CY, Yu JH, Huang HK, Huang YC, Wang JP. Tendon repair with intercalated partial extensor carpi radialis longus tendon graft for chronic extensor pollicis longus tendon rupture. J Chin Med Assoc. 2021 Jul; 1;84(7):728-732.
  • Willkomm LM, Bickert B, Harhaus L. Secondary reconstruction in zones V-VII in extensor tendon injuries. Unfallchirurg. 2021; 124(4):294-302.
  • Brebels J, Mignon A. Polymer-Based Constructs for Flexor Tendon Repair: A Review. Polymers. 2022;14, 867.
  • Ergüner H, İnanır M, Dursun N, Dursun E. Travmatik El Yaralanmalı Hastalarımızın Klinik Özellikleri. Romatoloji ve Tıbbi Rehabilitasyon Dergisi. 2002; 13: 243-251.
  • Yeşiloğlu N. Fleksor tendon onarımlarında erken mobilizasyon için geliştirilen etfal-ny dikiş tekniğinin in vitro ve in vivo sonuçlarının modifiye kessler tekniği ile karşılaştırılması (Uzmanlık tezi), İstanbul, Türkiye: Sağlık Bakanlığı Şişli Etfal Eğitim ve Araştırma Hastanesi I. Plastik ve Rekonstrüktif Cerrahi Kliniği (Klinik Şefi: Prof. Dr. Lütfü BAŞ), 2008.
  • Yammine K, Saghie S, Assi C. A Meta-Analysis of the Surgical Availability and Morphology of the Plantaris Tendon. The Journal of Hand Surgery (Asian-Pacific Volume). 2019;Jun;24(2):208-218.
  • Jakubietz MG, Jakubietz DF, Gruenert JG, Zahn R, Meffert RH, Jakubietz RG. Adequacy of Palmaris Longus and Plantaris Tendons for Tendon Grafting. J Hand Surg [Am]. 2011;36:695–698.
  • Thorne CH, Beasley RW, Aston SJ, Bartlett SP, Gurtner GC, Spear SL. Grabb&Smith’s Plastic Surgery Kitabı, 6. Baskı, Ankara, Güneş Tıp Kitapevi. 2010:345-392.
  • Jones M, Abrahams PH, Sa-udo JR, Campillo M. Incidence and morphology of accessory heads of flexor pollicis longus and flexor digitorum profundus (Gantzer’s muscles). The Journal of Anatomy. 1997; 191: 451-455.
  • Vollala VR, Nagabhooshana S, Bhat SM, Potu BK, Rakesh V. Multiple accessory structures in the upper limb of a single cadaver. Singapore Med J. 2008; 49: 254-258.
  • Campos D, Nazer MB, Bartholdy LM. Anatomical variation of the accessory muscle of the forearm (Gantzer’s muscles) and his relationship with the median nerve: a case report in human. Braz J Morphol Sci. 2009; 26: 39-41.
  • Gorantla VR, Potu BK, Jetti R, Vollala VR, Pulakunta T. Rare origin of two accessory bellies from the undersurface of the flexor digitorum superficialis muscle. European Journal of General Medicine. 2009; 6: 57-59.
  • Trofa PD, Constant M, Crutchfield C, et al. Return-to-Sport Outcomes After Primary Ulnar Collateral Ligament Reconstruction With Palmaris Versus Hamstring Tendon Grafts: A Systematic Review. Orthopaetic Journal of Sports Medicine. 2021; 9(12): 23259671211055726.
  • Dabrowski K, Jozwicka HS, Kowalczyk A, Markuszewski M, Ciszek B. The sonographic morphology of musculus palmaris longus in humans. Folia Morphol. 2018;77(3):509-513.
  • Yammine K, Eric M. Morphometric analysis and surgical adequacy of palmaris longus as a tendon graft. A systematic review of cadaveric studies. Surgical and Radiologic Anatomy. 2019;42:259-267
  • Wehbe MA. Tendon graft donor sites. J Hand Surg [Am]. 1992; 17:1130-1132
  • Carlson GD, Botte MJ, Josephs MS, et al. Morphologic and biomechanical comparison of tendons used as free grafts. J Hand Surg [Am]. 1993;18:76-82.
  • Mazurek T, Strankowski M, Ceynowa M, Marek Rocławski M. Tensile strength of a weave tendon suture using tendons of different sizes. Clinical Biomechanics. 2011; 26(4):415-418.
  • Josipović M, Vlaić J, Serdar J, et al. Plantaris tendon: a novel graft for anterolateral ligament reconstruction and additional reinforcement for anterior cruciate ligament autografts in combined reconstructive procedures. Knee Surgery, Sports Traumatology, Arthroscopy. 2020 Aug;28(8):2604-2608.
  • Lynch TB, Bates TJ, Grosskopf TS, Achay JA, Nuelle CW, Nuelle JAV. Alternate graft options for staged-flexor tendon reconstruction: a cadaveric study of hamstring autografts compared to conventional autografts. J Hand Surg Am. 2022; Jun 13;S0363-5023(22)00211-8.
  • Moore T, Anderson B, Seiler JG. Flexor Tendon Reconstruction. The Journal of Hand Surgery. 2010; 35(6), 1025–1030.
  • Hohmann E, Keough N, Glatt V, Tetsworth K, Putz R, Imhoff A. The mechanical properties of fresh versus fresh-frozen and preserved (Thiel and formalin) long head of biceps tendons: a cadaveric investigation. Annals of Anatomy. 2019; 221:186–191.
  • Estermann SJ, Streffleur SF, Hirtler L, Streicher J, Pahr DH, Reisinger A. Comparison of Thiel preserved, fresh human, and animal liver tissue in terms of mechanical properties. Annals of Anatomy. 2021; 236:151717.
  • Verstraete MA, Straeten CVD, Lepeleere BD, Opsomer GJ, Hoof TV, Victor J. Impact of Drying and Thiel Embalming on Mechanical Properties of Achilles Tendons. Clinical Anatomy. 2015;28:994–1001.

Investigation of the use tendon of the accessory head of flexor digitorum profundus muscle as an alternative graft

Year 2022, Volume: 15 Issue: 2, 263 - 272, 31.08.2022
https://doi.org/10.26559/mersinsbd.1114923

Abstract

Aim: In recent years, tendon transfers have become one of the most frequently performed operations with increasing surgical reconstruction techniques. Tendon graft applications have become a necessity as a result of traffic accidents, sharp tool injuries or degenerative damage caused by some rheumatic diseases. The most commonly used tendon graft donors in the literature are palmaris longus muscle, plantaris muscle, extensor digitorum longus muscle, extensor indicis muscle and gracilis muscle. Although there are many tendon graft donors, alternative tendon graft donors are needed from time to time due to different areas of use and variability. Based on this, we aimed to investigate the usability of the accessory head of the flexor digitorum profundus muscle as a tendon graft. Method: In our study, we investigated whether the tendon of the accessory head of flexor digitorum profundus muscle could be a donor site for tendon grafting in two steps. Morphometric suitability in the first step and biomechanical suitability in the second step were tested and compared with currently used palmaris longus muscle and plantaris muscle tendons. For this purpose, palmaris longus muscle, plantaris muscle and the accessory head of flexor digitorum profundus muscle tendons were used. The lengths, thicknesses and widths of the muscles and tendons taken from 11 adult cadavers were measured. Obtained parameters were compared with each other. The length and width of the extremities from which they were taken were also measured and the correlations between them and the tendons were checked. By using tensile device; maximum rupture force, maximum deformation, stored energy, stiffness, maximum stress, maximum strain, flexibility coefficient and endurance parameters were measured and biomechanical properties of tendons were evaluated. Results: Similarities were obtained in both morphometric and biomechanical datas. Conclusion: As a result, it was determined that the considered accessory tendon was morphometrically suitable and partially sufficient biomechanically

Project Number

BAP-SBE TTB (YG) 2013-4 YL

References

  • Alagoz MS, Uysal AC, Tuccar E, Tekdemir I. Morphologic assessment of the tendon graft donor sites: palmaris longus, plantaris, tensor fascia lata. The Journal Of Craniofacial Surgery. 2008;19(1): 246-250.
  • Rosas S, Mesa C, Mesa F. The abductor pollicis longus tendon as an alternative graft in hand surgery. J Hand Surg Am. 2017; 42(3):205-208.
  • Al-Qattan MM, Mohrij SAA. A modified technique of two-staged extensor tendon reconstruction in zones 6–8 in a patient with absent palmaris/plantaris tendons: A case report. Int J Surg Case Rep. 2019;55:99-102.
  • Park DH, Gill IR, Solan MC. Flexor digitorum longus tendon harvest length utilising a limited operative exposure: A cadaveric study. Foot and Ankle Surgery. 2013; 19(1):53–55.
  • Thompson NW, Mockford BJ, Cran GW. Absence of the palmaris longus muscle: a population study. The Ulster Medical Journal. 2001;70(1): 22-24.
  • Lo IN, Yin CY, Yu JH, Huang HK, Huang YC, Wang JP. Tendon repair with intercalated partial extensor carpi radialis longus tendon graft for chronic extensor pollicis longus tendon rupture. J Chin Med Assoc. 2021 Jul; 1;84(7):728-732.
  • Willkomm LM, Bickert B, Harhaus L. Secondary reconstruction in zones V-VII in extensor tendon injuries. Unfallchirurg. 2021; 124(4):294-302.
  • Brebels J, Mignon A. Polymer-Based Constructs for Flexor Tendon Repair: A Review. Polymers. 2022;14, 867.
  • Ergüner H, İnanır M, Dursun N, Dursun E. Travmatik El Yaralanmalı Hastalarımızın Klinik Özellikleri. Romatoloji ve Tıbbi Rehabilitasyon Dergisi. 2002; 13: 243-251.
  • Yeşiloğlu N. Fleksor tendon onarımlarında erken mobilizasyon için geliştirilen etfal-ny dikiş tekniğinin in vitro ve in vivo sonuçlarının modifiye kessler tekniği ile karşılaştırılması (Uzmanlık tezi), İstanbul, Türkiye: Sağlık Bakanlığı Şişli Etfal Eğitim ve Araştırma Hastanesi I. Plastik ve Rekonstrüktif Cerrahi Kliniği (Klinik Şefi: Prof. Dr. Lütfü BAŞ), 2008.
  • Yammine K, Saghie S, Assi C. A Meta-Analysis of the Surgical Availability and Morphology of the Plantaris Tendon. The Journal of Hand Surgery (Asian-Pacific Volume). 2019;Jun;24(2):208-218.
  • Jakubietz MG, Jakubietz DF, Gruenert JG, Zahn R, Meffert RH, Jakubietz RG. Adequacy of Palmaris Longus and Plantaris Tendons for Tendon Grafting. J Hand Surg [Am]. 2011;36:695–698.
  • Thorne CH, Beasley RW, Aston SJ, Bartlett SP, Gurtner GC, Spear SL. Grabb&Smith’s Plastic Surgery Kitabı, 6. Baskı, Ankara, Güneş Tıp Kitapevi. 2010:345-392.
  • Jones M, Abrahams PH, Sa-udo JR, Campillo M. Incidence and morphology of accessory heads of flexor pollicis longus and flexor digitorum profundus (Gantzer’s muscles). The Journal of Anatomy. 1997; 191: 451-455.
  • Vollala VR, Nagabhooshana S, Bhat SM, Potu BK, Rakesh V. Multiple accessory structures in the upper limb of a single cadaver. Singapore Med J. 2008; 49: 254-258.
  • Campos D, Nazer MB, Bartholdy LM. Anatomical variation of the accessory muscle of the forearm (Gantzer’s muscles) and his relationship with the median nerve: a case report in human. Braz J Morphol Sci. 2009; 26: 39-41.
  • Gorantla VR, Potu BK, Jetti R, Vollala VR, Pulakunta T. Rare origin of two accessory bellies from the undersurface of the flexor digitorum superficialis muscle. European Journal of General Medicine. 2009; 6: 57-59.
  • Trofa PD, Constant M, Crutchfield C, et al. Return-to-Sport Outcomes After Primary Ulnar Collateral Ligament Reconstruction With Palmaris Versus Hamstring Tendon Grafts: A Systematic Review. Orthopaetic Journal of Sports Medicine. 2021; 9(12): 23259671211055726.
  • Dabrowski K, Jozwicka HS, Kowalczyk A, Markuszewski M, Ciszek B. The sonographic morphology of musculus palmaris longus in humans. Folia Morphol. 2018;77(3):509-513.
  • Yammine K, Eric M. Morphometric analysis and surgical adequacy of palmaris longus as a tendon graft. A systematic review of cadaveric studies. Surgical and Radiologic Anatomy. 2019;42:259-267
  • Wehbe MA. Tendon graft donor sites. J Hand Surg [Am]. 1992; 17:1130-1132
  • Carlson GD, Botte MJ, Josephs MS, et al. Morphologic and biomechanical comparison of tendons used as free grafts. J Hand Surg [Am]. 1993;18:76-82.
  • Mazurek T, Strankowski M, Ceynowa M, Marek Rocławski M. Tensile strength of a weave tendon suture using tendons of different sizes. Clinical Biomechanics. 2011; 26(4):415-418.
  • Josipović M, Vlaić J, Serdar J, et al. Plantaris tendon: a novel graft for anterolateral ligament reconstruction and additional reinforcement for anterior cruciate ligament autografts in combined reconstructive procedures. Knee Surgery, Sports Traumatology, Arthroscopy. 2020 Aug;28(8):2604-2608.
  • Lynch TB, Bates TJ, Grosskopf TS, Achay JA, Nuelle CW, Nuelle JAV. Alternate graft options for staged-flexor tendon reconstruction: a cadaveric study of hamstring autografts compared to conventional autografts. J Hand Surg Am. 2022; Jun 13;S0363-5023(22)00211-8.
  • Moore T, Anderson B, Seiler JG. Flexor Tendon Reconstruction. The Journal of Hand Surgery. 2010; 35(6), 1025–1030.
  • Hohmann E, Keough N, Glatt V, Tetsworth K, Putz R, Imhoff A. The mechanical properties of fresh versus fresh-frozen and preserved (Thiel and formalin) long head of biceps tendons: a cadaveric investigation. Annals of Anatomy. 2019; 221:186–191.
  • Estermann SJ, Streffleur SF, Hirtler L, Streicher J, Pahr DH, Reisinger A. Comparison of Thiel preserved, fresh human, and animal liver tissue in terms of mechanical properties. Annals of Anatomy. 2021; 236:151717.
  • Verstraete MA, Straeten CVD, Lepeleere BD, Opsomer GJ, Hoof TV, Victor J. Impact of Drying and Thiel Embalming on Mechanical Properties of Achilles Tendons. Clinical Anatomy. 2015;28:994–1001.
There are 29 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

İsmail Yağmurhan Gilan 0000-0002-3617-1042

Coşar Uzun 0000-0002-5950-9173

Vedia Bennu Gilan 0000-0002-7119-221X

Alev Bobus Örs 0000-0003-4026-5460

Nurten Erdal This is me 0000-0003-0541-7983

Project Number BAP-SBE TTB (YG) 2013-4 YL
Publication Date August 31, 2022
Submission Date May 10, 2022
Acceptance Date July 4, 2022
Published in Issue Year 2022 Volume: 15 Issue: 2

Cite

APA Gilan, İ. Y., Uzun, C., Gilan, V. B., Bobus Örs, A., et al. (2022). Musculus flexor digitorum profundus aksesuar başı tendonunun alternatif greft olarak kullanılabilirliğinin araştırılması. Mersin Üniversitesi Sağlık Bilimleri Dergisi, 15(2), 263-272. https://doi.org/10.26559/mersinsbd.1114923
AMA Gilan İY, Uzun C, Gilan VB, Bobus Örs A, Erdal N. Musculus flexor digitorum profundus aksesuar başı tendonunun alternatif greft olarak kullanılabilirliğinin araştırılması. Mersin Univ Saglık Bilim derg. August 2022;15(2):263-272. doi:10.26559/mersinsbd.1114923
Chicago Gilan, İsmail Yağmurhan, Coşar Uzun, Vedia Bennu Gilan, Alev Bobus Örs, and Nurten Erdal. “Musculus Flexor Digitorum Profundus Aksesuar başı Tendonunun Alternatif Greft Olarak kullanılabilirliğinin araştırılması”. Mersin Üniversitesi Sağlık Bilimleri Dergisi 15, no. 2 (August 2022): 263-72. https://doi.org/10.26559/mersinsbd.1114923.
EndNote Gilan İY, Uzun C, Gilan VB, Bobus Örs A, Erdal N (August 1, 2022) Musculus flexor digitorum profundus aksesuar başı tendonunun alternatif greft olarak kullanılabilirliğinin araştırılması. Mersin Üniversitesi Sağlık Bilimleri Dergisi 15 2 263–272.
IEEE İ. Y. Gilan, C. Uzun, V. B. Gilan, A. Bobus Örs, and N. Erdal, “Musculus flexor digitorum profundus aksesuar başı tendonunun alternatif greft olarak kullanılabilirliğinin araştırılması”, Mersin Univ Saglık Bilim derg, vol. 15, no. 2, pp. 263–272, 2022, doi: 10.26559/mersinsbd.1114923.
ISNAD Gilan, İsmail Yağmurhan et al. “Musculus Flexor Digitorum Profundus Aksesuar başı Tendonunun Alternatif Greft Olarak kullanılabilirliğinin araştırılması”. Mersin Üniversitesi Sağlık Bilimleri Dergisi 15/2 (August 2022), 263-272. https://doi.org/10.26559/mersinsbd.1114923.
JAMA Gilan İY, Uzun C, Gilan VB, Bobus Örs A, Erdal N. Musculus flexor digitorum profundus aksesuar başı tendonunun alternatif greft olarak kullanılabilirliğinin araştırılması. Mersin Univ Saglık Bilim derg. 2022;15:263–272.
MLA Gilan, İsmail Yağmurhan et al. “Musculus Flexor Digitorum Profundus Aksesuar başı Tendonunun Alternatif Greft Olarak kullanılabilirliğinin araştırılması”. Mersin Üniversitesi Sağlık Bilimleri Dergisi, vol. 15, no. 2, 2022, pp. 263-72, doi:10.26559/mersinsbd.1114923.
Vancouver Gilan İY, Uzun C, Gilan VB, Bobus Örs A, Erdal N. Musculus flexor digitorum profundus aksesuar başı tendonunun alternatif greft olarak kullanılabilirliğinin araştırılması. Mersin Univ Saglık Bilim derg. 2022;15(2):263-72.

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