A tendon is a firm cord attached to the bone at both ends of a muscle, which enables the movement of your joints. Numerous muscles are present in your body, but some of them might stop functioning properly because of an injury or unwanted force. 

To fix that situation and make these muscles and tendons work appropriately, Tendon Transfer Surgery is done to replace these malfunctioning or disabled muscles/tendons. 

During the surgery, when a tendon gets damaged, the doctor performs surgery and replaces the damaged tendon with a functional one so that the routine tasks do not get affected by the damaged tendon.

What is tendon transfer surgery?

In simple words, a type of hand surgery performed to replace the non-working/damaged tendon present in the hand with an appropriately functioning tendon so that the quality of the work stays intact and routine activities do not get affected by the damaged tendon. 

They will add a perfectly working tendon to a new place in place of the damaged tendon existing to restore the potential of the hand. 

Tendon Transfer Surgery becomes mandatory when a particular muscle loses its potential and functioning because of an injury. When a muscle gets damaged because of an injury, it is longer able to receive the signals sent by the nerve due to which the muscle gets paralyzed and the functioning of that muscle is lost. 

The spinal cord, Radial nerve, Ulnar nerve, or Median nerve injury are a few instances of injuries that are usually treated with Tendon Transfer Surgery.

Indications of the tendon transfer surgery:

  • Severe injuries such as Spinal cord and Ulnar nerve injuries wherein a nerve is damaged resulting in the lost function of a muscle can be cured by Tendon Transfer Surgery.
  • Surgery for tendon transfer can be used to address a wide range of disorders. A nerve can no longer communicate with particular muscles if it is damaged and cannot be healed. It is therefore necessary to do the tendon transfer procedure.
  • When a muscle ruptures and cannot be healed, tendon transfer surgery may also be required. Additionally, tendon transfer surgery may be used to address tendon lacerations that are irreparable after damage.
  • Tendon transfers may address muscle instability muscle Cerebral palsy, stroke, traumatic brain injury, and spinal muscular atrophy are common nervous system conditions that are treated by tendon transfer surgery.
  • Finally, several disorders prevent some muscular functions from developing in newborns. In some cases, tendon transfer surgery can even restore the absent muscle functions. 

Treatment

The surgeons will perform the surgery while you're asleep or while you're awake with mild sedation of the body part where the surgery will be done. The dosage of Anesthesia varies as per the severity of the injury. 

During the procedure, the doctor will cut or two to replace the damaged tendon with the functional one. The damaged tendon is removed and the tendon of extra muscle or an extra tendon of a significant muscle is placed and sewn where the damaged tendon existed. After replacing the damaged tendon, the surgeon closes the incision with stitches. 

After the completion of your surgery, you will be provided with a cast or a splint to protect the tendon transfer and the stitches until the replaced tendon settles with the new muscle and the incision is closed. 

Furthermore, hand therapy is advisable to put the hand back in its regular motion. Although, it is mandatory to follow the instructions given by the physiotherapist because excess or lack of exercise can have undesirable outcomes.

In addition to Tendon Transfer Surgery, there are other options available to fix the situation:

  1. Splinting/fusion of joints
  2. Transfer/repair of nerves
  3. Repair of muscle/tendon

Risks

Every surgery has some risk, some risks are significant while some are not. Despite early risks or complications being uncommon during this procedure, given below is a list of early risks:

  • Bleeding
  • Infection/viruses
  • Negative effect on other tendons.
  • Damage to nearby nerves/blood vessels.

Moreover, later risks are enlisted below:

  • Stiffness
  • Weakness of the replaced tendon.
  • Rupture of the transferred tendon.
  • Malfunctioning of the muscle consisting of a replaced tendon.
  • The transferred tendon may tear if movement occurs too soon. 
  • Late movement can cause the tendon to scar excessively. 

You can better understand the dangers and advantages of tendon transfer surgery by discussing your particular case with your hand surgeon.

Principles of tendon transfer

Several principles have been established to enhance the potential and success rate of tendon transfer surgeries over the last century. Even though sticking with these principles might not result in complete success, ignoring them will have failed outcomes.

We have enlisted a few principles of tendon transfer below: 

  1. Soft tissue equilibrium: A transfer route through the soft tissue bed should reach the equilibrium as soon as the surgery is completed. It should be able to glide freely and does not consist of any complications such as inflammation. A transfer with bias might cause a reduced effect of the surgery.
  1. Supple joints: Patients with stiff joints are mainly the ones suffering from upper extremity nerve palsies. In such conditions, a tendon transfer isn't helpful. Surgical release or hand therapy is essential to maximize the movement to perform a tendon transfer. It is mandatory to avoid contracture or joint release while performing tendon transfer surgery.
  1. Expendable donor: It is mandatory to consider the potential shortfall that'll take place because of a tendon transfer surgery. Restoring one essential function at the cost of another equally important function might not be a smart decision. 
  1. The donor of efficient strength: The strength of both, the donor and the receiver must be equal. It implies that the donor must be strong and efficient enough to achieve the desired movement because a weak donor won't be able to move the targeted joint from a range, especially if there's any stiffness. It is advisable to compare relative muscle strength to absolute muscle strength while considering potential donors for the transfer. 

Post-operative care

In most cases, all kinds of surgeries require at least 1-2 months to recover completely. And it is important to take appropriate care during this period. The surgeon will also provide a split to protect the replaced tendon and provide efficient time to close the incision during this time. 

As soon as the incision is closed and the replaced tendon settles down, the cast is removed and your surgeon might advise you to perform several hand exercises or go for physiotherapy to restore the normal movement and potential of your hand. 

During this period, it is necessary to take care of your activities as excess and lack of movement might result in rupture of the transfer or stiffness & scarring of the tendon. 

Why choose Cutis Hospital for Tendon Transfer Surgery?

Cutis Hospital is the leading hospital with skilled surgeons, equipment, standard procedure, and best-in-class patient care for desired results and patient care. 

Skilled surgeons 

It is mandatory to ensure the severity of the injury to take a proper decision for treatment. As different types of treatment can be opted for in case of a tendon injury, it is necessary to opt for the most suitable one to ensure the safety of the patient. Doctors at Cutis possess complete theoretical knowledge and years of practical experience regarding tendon injuries and Tendon Transfer Surgeries. 

End-to-End patient care 

These experts try to keep the incision as small as possible and try to complete the surgery in as less time as possible. It helps the patient by reducing pain while also minimizing the consumption of antibiotics. Besides that, specialists at Cutis also take proper care of stitches and cover them completely, which protects the stitches from getting infected and makes the condition worse.

Proper post-operative care 

Moreover, as these surgeries require more than a month or two to recover completely these doctors also provide appropriate aftercare once the surgery is over. These doctors will prescribe proper medication to protect the incision from getting infected. The equipment used to perform surgeries is also maintained and cleaned thoroughly by the staff, which helps in preventing diseases caused by unclean surroundings and makes the situation worse.

If you have the symptoms and are looking for an accurate diagnosis & best treatment, then reach out to us right away!

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    Before and After Surgery

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    Hand Surgery_Multiple extensor tendon injury_case 1
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    Hand Surgery_Multiple extensor tendon injury_case 2
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    Hand Surgery_Avulsed extensor tendons of index finger_case 2

    FAQ's

    It is necessary to undergo tendon transfer surgery to replace the damaged tendon. Otherwise, the infection will spread, resulting in problems later on.

    It takes roughly 1-2 months for tendon transfer surgery to recover completely.

    Yes, if appropriate aftercare is not done and the stitches are not covered properly, then there’s a high chance of the wound getting infected.

    No, the surgery can also be performed by sedating only the body that is supposed to undergo the surgery.

    Yes, the surgery and incision might be excruciatingly painful, but painkillers given in the form of injections and tablets will suppress the pain to some extent.

    Yes, hand therapy and exercises are necessary to recover your hands’ lost movement and potential.

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