The correction of ulnar claw fingers: a follow-up study comparing the extensor-to-flexor with the palmaris longus 4-tailed tendon transfer in patients with leprosy.

Purpose: The extensor to flexor 4-tailed tendon transfer (EF4T) and the palmaris longus 4-tailed tendon transfer (PL4T) are 2 surgical procedures used to correct intrinsic paralysis of the hand in leprosy. The EF4T traditionally is the more common procedure and requires the transfer of a wrist extensor muscle. The PL4T requires the transfer of the palmaris longus and morbidity is expected to be lower. A follow-up study was performed to determine whether the clinical outcome of the PL4T is superior to the EF4T procedure in leprosy patients with ulnar claw fingers that are considered mobile before surgery.

Methods: Fifty-five patients presented 65 affected hands, of which 40 hands had the PL4T and 25 had the EF4T procedure. Each hand was assessed before surgery and at follow-up evaluation by predetermined angle measurements, standardized photographs, mechanical function, and patient satisfaction. Each hand was given an overall technical grade according to previously published standards.

Results: After an average follow-up period of 33 months there was no statistically significant difference in the technical outcome or patient satisfaction between the 2 tendon transfer procedures.

Conclusions: Whenever the palmaris longus is available it may be considered to be the motor tendon of choice to undertake a many-tailed procedure for claw finger reconstruction in mobile hands paralyzed by leprosy. The palmaris longus should be considered as a possible motor tendon when correcting intrinsic muscle paralysis of the hand.