It has been scheduled.InsyaAllah tomorrow morning I'll be joining my boss elective operation.Just finishing doing pre-op round today.One of the patient is a young lady with the congenital Erb's palsy.She is planned for right wrist tendon transfer KIV wrist fusion.
" who will join the OT tomorrow ? " Mr zairuddin, my ward specialist asked.
" Me, Mr zai.."
"..so you should have a look and read about tendon transfer " He encouraged while smiling.
Alhamdulillah...I just read about Principles of tendon transfer described by Roger Dee.Basically, there are 5 principles which have been outlined by Mayer, Steindler, Bunnell and Boyers.
Before that, what does it means by tendon transfer?
It is defined as " procedure in which the tendon of insertion or of origin of the functioning muscle is mobilized, detached, or divided, and reinserted into a bony part or into another tendon to supplement or substitute for the action of the recipient tendon "
Principles of Tendon Transfer
1. Correction of contractures
The joints must be freely movable, because a transferred tendon unit cannot overcome a fixed joint contracture.the skin and soft tissue must be supple and free of scarring.
2. Adequate power in the transfer
The muscle must be strong enough to perform the desired function.Thus, only muscles rated 4+, 5 or better should be considered acceptable donor.
3. Sufficient amplitude in the Transfer
The amplitude is a function of muscle sarcomere length.One should choose a donor with more than adequate amplitude for the desired function.The work capacity of a muscle is determined by the product of its power and amplitude.
4. Satisfactory Line of pull
The best course for a tendon transfer is a straigt line of pull througgh unscarred soft tissue.Each turn or bend in the transferred tendon can set up a point of friction, causing loss of effective power and amplitude.
5. Functional integrity
The transferred tendon cannot be expected to perform more than one function or to have separate amplitudes for different motions.The transferred muscle tendon unit must be expendable.For example, if both the FCR and FCU tendons are tranferred to the dorsum of the hand and wrist, active wrist flexion will be lost !
Hopefully we can learn something and may the operation tomorrow will be successful.May Allah bless.
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