Predicting Tendon Tissue Grafting Source From the Extensors of LongFingers: A Systematic Review of Cadaveric Studies

摘要

Background: The use of tendon tissue for transfer and grafting is acommon practice in hand surgery. Many local tendons are usually used, mainlythat of the palmaris longus muscle. However, this tendon could be absent in upto 46%. Extra slips of the extensor digitorum communis (EDC) and extra tendonssuch as the extensor indicis (EI) and the extensor digiti minimi (EDM) could bevaluable sources for tendon tissue. Methods: A systematic reviewwas conducted to quantify the proportion of extra slips in relation to eachtendon and extra tendons in relation to each long finger. The aim is to betterpredict the location of tendon tissue sources on the dorsum of the hand inreconstructive surgery. Results: Based on 39 studies including 7847hands, the cumulative frequencies of extra slips and extra tendons and theassociation between double-slip frequency and ancestry were as follows: (1) thelittle finger showed the highest cumulative frequency of extra slips (96.54%),followed by the ring (37.5%), long (30.6%), and index (9.5%) fingers; (2) theindex with its EI and its variants and the little finger with its EDM bear byfar the highest cumulative frequency of extra tendons (≈100%); and (3) doubleslips are found to be rare in Indian populations, most prevalent in Japanesepopulations, more prevalent in the index and little fingers of Caucasians, andmore prevalent in the ring fingers of Middle Eastern populations.Conclusions: Knowledge of the frequencies of extra slips foreach long extensor tendon and extra tendons for each long finger along withtheir prevalence in different populations would improve: (1) location previsionof tendon source for tendon grafting; and (2) surgical planning while supportinga patient-centered approach. Evidence-based hand anatomy would have a majorpotential to contribute to the practice of an evidence-based hand surgery.Predicting the possible tendon sources that could be present on the dorsum ofthe hand is thought to be very valuable for hand surgeons. In addition and froman evolutionary perspective, we hypothesized that the observed significantlyhigher frequency values of the double-slip and triple-slip types of the EDC ofthe ring finger, EDC of the little finger, and EDM might indicate a naturalselection tendency for a higher independence of the former digits in the futureevolution of the human hand.