Key notes on plastic surgery/Adrian M. Richards

• The ideal tension varies between transfers.
TENDON TRANSFERS 219
• Extensor indicis (EI) to EPL transfers should be tight as tend to loosen.
• Opponensplasties should be looser to avoid an adduction deformity of the
thumb.
Radial nerve palsy
Motor deficits
• Decreased wrist extension
• Decreased finger extension
• Decreased thumb abduction and extension.
Tendon transfers
Classic transfer
• PT to ECRB
• FCU to EDC
• PL to EPL.
Superficialis transfer
• This was described by Boyes as an alternative to the classic transfer.
• It consists of the following:
• PT to ECRL and ECRB
• FDS of the middle finger (FDS 3) to EDC
• FDS of the ring finger (FDS 4) to EIP and EPL
• FCR to APL and extensor pollicis brevis (EPB).
Median nerve palsy
Motor deficits
• The main functional deficit is lack of thumb opposition due to denervation of
the thenar eminence.
• APB is the thenar eminence muscle most reliably supplied by the median
nerve.
• Flexor pollicis brevis (FPB) and opponens pollicis are often partially supplied by
the ulnar nerve.
• Consequently, some patients with low median nerve palsies still have adequate
thumb opposition.
Tendon transfers
Tendon transfers to restore thumb opposition are known as opponensplasties.
There are four main types of opponensplasty.
The Royle–Thompson opponensplasty
• FDS 4 is divided at its distal attachment.
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