الفهرس 
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Abstract
The upper limb is a mobile system of joints and levers for positioning the hand, a skillful organ capable of complicated tasks of exploration, gripping and manipulation, which require great precision and accuracy. The movements of the hand are based on the act of the musculo-tendinous insertions to the hand skeleton that lead to the desired motion upon free mobile joints. The function of the tendon is to transmit the force of the muscle to the bone where the the tendon inserted.
Tendons are made up of connective tissue known as collagen. The healing process of an injured or compromised tendon passes throughout three main phases containing distinctive cellular and molecular cascades which are inflammatory, proliferative and remodeling stages. Two cellular mechanisms of tendon healing, known as extrinsic and intrinsic healing, have been suggested.
A ‘tendon transfer’ is the operative relocation of a muscle–tendon unit (MTU), along with its neurovascular structures, to a different anatomical site in order to achieve or augment a lost function. The procedure involves detaching the tendon insertion, mobilizing the muscle and reattaching the distal tendon into a recipient tendon or bone insertion site. Tendon transfers follow a basic concept of reconstructive surgery:Nothing new is created, but functional parts are rearranged into the best possible working combination.
Tendon injuries are the second most common hand injury type. Most tendon injuries require surgical repair and rehabilitation to restore hand function. Tendon functions were the best in primary repair and they got worse as delay become longer, repair in late stage produce significantly worse tendon functions concluded that optimal timing for tendon repair is at the primary stage.
Delayed management of cut tendon in the hand may be due to one of many causes that make the meaning of the old cut tendon repair. Restoration of satisfactory digital function in management of old cut tendon remains one of the most difficult challenges in hand surgery. A hand surgeon must be skilled in all of management options because intraoperative findings may necessitate a departure from the planned procedure.
The most common used method in management of old neglected cut tendon in the hand is the two staged tendon reconstruction using tendon spacer or one of its alternatives followed by placement of tendon graft. Using a tendon spacer in the first stage and a free tendon graft through the pseudosheath formed around the spacer in the second stage.
In this thesis we present a new idea for management of old cut tendon in the hand by tendon transfer to overcome the resulted muscle atrophy of the non-contractile muscle tendon and also to pass the bad effect of fibrosis of old cut tendon and its wide gap. The choice of patients with old cut tendon injury that had occurred more than six months based on that the muscle of the affected tendon will be in a state of hypotrophy or mostly disused atrophied. The aim of this study was to assess the techniques and efficacy of variable methods of tendon transfers in management of old cut tendons in the hand.
Summary
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The study was a prospective interventional study that included 26 patients divided into two groups. group A: patients with old cut tendon in the Thumb, group B: Includes patients with old cut flexor tendons in the fingers. The suitable available tendon is transferred to distal end of the old cut tendon.
Plan of study: Tendon transfer method for the old cut tendon in the hand by harvesting a healthy tendon that its loss will not affect the function of the finger it acts on it. Extensor indicis (E.I.) tendon is harvested and transferred for the old cut Extensor pollicis longus (E.P.L.) tendon, Flexor digitorum superfacialis (F.D.S.) tendon of the ring finger for old cut Flexor pollicis longus (F.P.L.) tendon and old cut flexor tendons of the little finger and at last (F.D.S.) tendon of the middle finger for old cut flexor tendons of the index finger.
For evaluation we compared postoperative range of motion (ROM) after six months with both preoperative (ROM) and normal range of motion (N.ROM). To evaluate the Total active motion (TAM) we used Strickland’s grading scale that evaluates the gained act motion after subtraction of the deficit in the counteract motion. As a total result for all our patients the results were 66.7% excellent, 20% good (i.e. excellent to good 86.7%), fair 13.3% and 0% poor. The complications were in the form of mild to moderate postoperative contracture in 30.8% of patients and mild infection was reported in 15.4% of the cases with 53.8% of the cases with no complications. For the thumb group the results were 71.4% excellent, 14.2% good (i.e. excellent to good 85.6%), fair 14.2% and 0% poor. As a total result for all our patients the results were 66.7% excellent, 20% good (i.e. excellent to good 86.7%), fair 13.3% and 0% poor.
Regarding (NROM) based on the guidelines of the American society for surgery of the hand the finger group that in case of cut flexor tendons of the fingers (little and index) there is a significant improvement and excellent results with 88.7% improvement of the distal interphlangeal joints (DIPJ), 88.4% improvement of the proximal interphlangeal joints (PIPJ) and 95.5% improvement of the metacarpophalangeal joint (MPJ) all in flexion movement. Regarding the thumb group, there is also a significant improvement and excellent results which is more obvious in case of reconstructed EPL than that of reconstructed FPL tendon. Improvement of the interphalangeal joint (IPJ) in flexion movement was 90.6% and in extension movement was 90%, with improvement of the metacarpophalangeal joint MPJ in flexion movement was 94.9% and 98% in extension movement.
Finally, putting in mind that tendon transfer is a single operation versus two procedures operation of the tendon spacer and tendon graft that decrease the hazardous effects of procedures operation, more economic for the patients and early function gain. Our study highlighted the benefits and improvement of the use of tendon transfer method for the treatment of old cut tendon in the hand especially for the long term past injury. Our findings have crucial implications for the clinicians and the patients as well as the health policy planners.