Single-stage reconstruction without grafting for neglected flexor pollicis longus tendon laceration in a child - A case report.

Abstract

Introduction: Lacerations of the flexor pollicis longus (FPL) tendon are rare in children and should be treated promptly. This study aims to present a rare case of a neglected FPL tendon laceration in a child, successfully managed with single-stage reconstruction without the use of grafts.

Case report: A 12-year-old patient was admitted to our hospital with an inability to flex the interphalangeal joint of the right thumb following an injury sustained 2 months earlier. Clinical examination revealed a neglected FPL tendon laceration in zone II. Intraoperatively, it was observed that the distal stump of the tendon measured approximately 1 cm, while the proximal stump was attached to the A1 pulley. In addition, the oblique pulley was narrowed, obstructing the passage of the tendon. To address this, a Z-plasty of the oblique pulley was performed. Following tendon debridement, a 2-cm-long tendon deficit was identified. A carpal tunnel release was conducted to facilitate further tendon mobilization. The distal stump was sutured, and a Z-plasty lengthening of the tendon by 1.5 cm was performed after assessing the "tenodesis effect." An extension block cast was applied after skin closure. Three weeks later, the patient was encouraged to perform active flexion-extension movements to the neutral position. By 6 weeks postoperatively, the patient was advised to perform full active range-of-motion exercises and physiotherapy. Four months after surgery, the patient had fully resumed pre-injury activities exhibiting full active flexion and a 10° extension deficit at the IP joint of the thumb.

Conclusion: In cases of neglected pediatric flexor tendon lacerations, single-stage tendon reconstruction without grafting can be a viable option to avoid complex surgical procedures and potentially unpredictable outcomes.