An experimental study comparing active mobilization to passive flexion-active extension-active flexion after flexor tendon repair in zone 2.

PURPOSE: Both passive flexion-active extension and active rehabilitation have shown advantages and disadvantages in tendon healing. The purpose of this study was to measure the effect of a combination of these 2 rehabilitation protocols. METHODS: A tendon injury model was used in white Leghorn chickens. Thirty-two animals were randomly assigned into 4 groups. We compared an unrestricted active flexion rehabilitation (UA) group with 3 groups starting passive flexion, active extension, and active flexion (PAA) at 5, 9.5 and 14 days after repair. The tensile properties and range of motion of the 3 interphalangeal joints were evaluated for 3 postoperative weeks. RESULTS: In terms of tensile properties of the operated foot, PAA-14 was higher than any other group, and PAA-5 was the lowest. There was no significant difference between the PAA-9.5 and UA. For the range of motion, there were significant differences between all 4 groups: UA increased the most, PAA-14 increased the least, and PAA-5 increased more than PAA-9.5. For the rupture rate, UA and PAA-5 were higher than were PAA-9.5 and PAA-14. CONCLUSIONS: The results indicate that the PAA-9.5 and UA may give the best balance (tensile properties, range of motion, rupture rates) of these rehabilitation protocols. PPA-9.5 and UA had similar moderate tensile properties. When considering an increased range of motion, the UA method may be the most appropriate despite its higher rupture rate. When considering a lower rupture rate, PAA-9.5 may be the most suitable. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Anatomical basis of a proximal fasciocutaneous extension of the distal-based posterior interosseous flap that allows exclusion of the proximal posterior interosseous artery.

OBJECTIVE: The objective of this study was to provide anatomical information for the repair of small tissue defects in the hand with posterior interosseous artery chain-link perforator flaps, a proximal fasciocutaneous extension of the distal-based posterior interosseous flap, which allows the exclusion of the proximal posterior interosseous artery. METHODS: Fourteen posterior interosseous artery chain-link perforator flaps taken from human cadavers were studied by the following three methods: latex perfusion for microanatomy analysis, denture material and vinyl chloride mixed packing for cast analysis, and latex perfusion for the production of clearance specimens. Statistical analysis was performed on cutaneous perforators coming from the intermuscular septum of the extensor carpi ulnaris and the extensor digitorum communis. A cluster analysis was conducted to determine the overall distribution of perforators. RESULTS: There are two main clusters of perforators at a relative distance of 21% and 48% along the ulnar head-to-lateral epicondyle interval. On average, the posterior interosseous artery extends six cutaneous perforators through the intermuscular septum of the extensor carpi ulnaris and the extensor digitorum communis. Of these six arteries, two are clinically significant perforators (0.5 mm or more in diameter) and are located 6 ± 2 cm proximal to the head of the ulna and 10 ± 1 cm distal to the lateral epicondyle of the humerus. Their mean diameters are 0.5 ± 0.1 and 0.6 ± 0.1 mm, with pedicle lengths of 16.8 ± 5.1 and 21.2 ± 12.3 mm, respectively. At the two main clusters of perforator-intensive sites, the vessel chains formed by adjacent perforators are parallel to the intermuscular septum of the extensor carpi ulnaris and the extensor digitorum communis. CONCLUSIONS: This study demonstrates that the posterior interosseous artery has two main clusters of perforators in the middle and distal one-fifth of the forearm, which can be used for repairing hand defects with posterior interosseous artery chain-link perforator flaps.