Long palmar muscle in humans. Why do people really need palm muscles

Incredible Facts

Some organs in the human body exist not because they serve a purpose, but because they were useful to our ancestors.

They remained as rudiments - physiological remnants of our evolutionary past.

Take a closer look and you will see that they make sense in terms of evolution by natural selection.

The structure of the human body

long palmar muscle

The long palmar muscle is a vestigial muscle of the forearm. This is a group of muscles that runs from the base of the palm up the arm.

It can be found among many mammals, but it is most developed in those who often use their forearms for movement, such as monkeys and lemurs. 10-15 percent of people no longer have this muscle, sometimes it is present in only one arm., although this does not affect the compression force.

This muscle is often removed by surgeons when needed. Plastic surgery in other parts of the body.

Anterior, superior and posterior ear muscle

Some people can wiggle their ears. The muscles that enable them to do this are vestigial: the anterior auricular, superior auricular, and posterior auricular muscle.

These same muscles allow other mammals to move their ears to hear sounds better and to identify their source.

In fact, people try to move their ears in the direction of the sound, but these movements are very small and can be picked up with electrodes.

Goosebumps

When we are cold, tiny the muscles attached to the hairs on our body contract and lift the hairs, which causes goosebumps on the skin.

In furry mammals, this creates better insulation and a more intimidating appearance in case of danger. Emotional music can also cause goosebumps, as it is triggered by the fight-or-flight response associated with the production of adrenaline.

Coccyx

The coccyx is also a relic of our ancestors' tail.

Each of us had a tail at some point in our development - around the fourth week of fetal development. Human embryos are very similar to those of other vertebrates, including the tail. However, in humans and other primates, tail cells are programmed to die.

It is a short spindle-shaped abdomen and a very long tendon, stretching almost from the elbow to the wrist. Oddly enough, 14% of people simply do not have it.

Anatomical experts argue that the absence of this tendon does not affect grip strength in any way. However, in case of any specific injury, when the need for transplantation arises, it is good source- a kind of spare part in the human body.

To check if you have it, gather all five fingers into a pinch and bend your wrist - the tendon is clearly visible in the wrist area, provided that it is present. In other mammals, this same tendon is responsible for extending the claws. Apparently, this is why some people do not have it - there is no need to release claws in our species.

Tendons can look very different from person to person. Just as individual is the number of tendons and muscles.

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1. Shoulder muscle; m. brachioradialis.

Surface layer

1. Elbow extensor of the wrist, m. extensor carpi ulnaris.
2. Finger extensor, m. extensor digitorum.
3. Extensor of the little finger, m. extensor digiti minimi.

The muscles of the forearm, mm.antebrachii, are divided into three groups according to their position: anterior, lateral (radial) and posterior. In this case, the muscles of the anterior and posterior groups are located in several layers. In the anterior group, the muscles lie in four layers.

First (surface layer)

1. Round pronator, m. pronator teres.
2. Radial flexor of the wrist, m. flexor carpi radialis.
3. Long palmar muscle, m. palmaris longus.
4. Elbow flexor of the wrist, m. flehor carpi ulnaris.

Second layer

1. Superficial flexor of fingers, m. flexor digitorum superficialis.

third layer

1. Deep finger flexor, m. flexor digitorum profundus.
2. Long flexor of the thumb, m. flexor pollicis longus.

fourth layer

1. Square pronator, m. pronator quadratus

The lateral (radial) group includes:

1. Shoulder muscle; m. brachioradialis.
2. Long radial extensor of the wrist, m. extensor carpi radialis longus.
3. Short radial extensor of the wrist, m. extensor carpi radialis brevis.

IN rear group muscles lie in two layers.

deep layer

1. Arch support, m.supinator
2. Abductor longus muscle thumb brushes, m. abductor pollicis longus.
3. Short extensor of the thumb, m. extensor pollicis brevis.
4. Long extensor of the thumb, m. extensor pollicis longus
5. Extensor of the index finger, m. extensor indicator.

Anterior forearm muscles

First (surface) layer

1. Round pronator, m. pronator teres, thickest and most short muscle this layer. It begins with two heads: a larger, humeral head, caput hwnerale, from epicondylus medialis humeri, septum intermusculare brachii mediale, fascia antebrachii, and a smaller, ulnar head, caput ulnare, originating from the medial edge of tuberositas ulnae. Both heads form an abdomen somewhat flattened from front to back, passing into a narrow tendon. The muscle goes obliquely from the inside to the outside and is attached to middle third facies lateralis radii. Action: penetrates the forearm and takes part in its flexion. Innervation: n. medianus (C6-C7). Blood supply: muscular branches aa. brachialis, ulnaris, radialis.
2. Radial flexor of the wrist, m. flexor carpi radialis, bipinnate, flat, longus muscle. It is located most laterally of all the flexors of the forearm. In the proximal part, the muscle is covered only by aponeurosis m. bicipis brachii and m. palmaris longus, and the rest, a large part of the muscle, is covered only by fascia and skin. The muscle starts from the epicondylus medialis humeri, septa intermuscularia and fascia antebrachii and, heading down, passes under the retinaculum flexorum to the base of the palmar surface of the II (III) metacarpal bone. Action: bends and penetrates the hand. Innervation: n. medianus [C6-C7-(C8)]. Blood supply: muscular branches a. radialis.
3. Long palmar muscle, m. palmaris longus, has a short spindle-shaped abdomen and a very long tendon. Lies directly under the skin medially from m. flexor carpi radialis. The muscle originates from the epicondylus medialis humeri, septum intermusculare and fascia antebrachii and, approaching the hand, passes into a wide palmar aponeurosis, aponeurosis palmaris. Action: stretches the palmar aponeurosis and takes part in the flexion of the hand. Innervation: n. medianus [(С7) С8]. Blood supply: muscular branches a. radialis.
4. Elbow flexor of the wrist, m. flexor carpi ulnaris, occupies the medial edge of the forearm. It has a long muscular abdomen and a relatively thick tendon.

Starts with two heads:

a) shoulder, caput humerale, from epicondylus medialis humeri and septum intermusculare;

b) elbow, caput ulnare, from olecranon, two upper thirds of facies dorsalis and fascia of the forearm.

Heading down, the tendon passes under the retinaculum flexorwn and attaches to the os pisiforme. A number of beams passes into lig. pisometacarpeum u lig. pisohamatum, which are attached to the hook-shaped and V metacarpal bones. Action: flexes the hand and participates in its adduction. Innervation: n. ulnaris (C8, Th1). Blood supply: a. collaterale, a. brachialis et a. ulnaris.

Second layer

Superficial flexor of fingers, m. flexor digitorum superficialis, covered in front m. palmaris longus and m. flexor carpi radialis, leaving a mark on it in the form of furrows. The muscle itself begins with two heads:

a) humerulnar, caput humeroulnare. long and narrow, from epicondylus medialis humeri et processus coronoideus ulnae;

b) radial, caput radiale. wide and short, from the proximal part of the palmar surface of the radius.

Both heads, uniting together into a common abdomen, end in 4 long tendons. The latter, passing to the hand, lie in the canalis carpi and are attached to the base of the middle phalanges from the index finger to the little finger. At the level of the proximal phalanges, each tendon is divided into two and therefore is attached not at one, but at two points - along the edges of the base of the middle phalanges. Action: bends the middle phalanges of the fingers from the index to the little finger. Innervation: n. medianus (C7-C8 Th1). Blood supply: a. radialis et ulnaris.

third layer

1. Deep finger flexor, m. flexor digitorum profundus, is a strongly developed, flat and wide abdomen, originating from the proximal half of the facies anterior ulnae and membrana interossea. The muscle goes down, passing into 4 long tendons, which, having passed under the retinaculum flexorum, lie in the canalis carpi, located under the tendons m. flexor digitorum superficialis. Then each of the tendons m. flexor digitorum profundus passes between the tendons of the superficial flexor of the fingers, attaching to the bases of the distal phalanges, from the index finger to the little finger. The tendons of the superficial and deep flexors of the fingers lie in the common synovial sheath of the flexors of the fingers of the hand, vagina synovialis communis mm. flexorum digitorum manus. Vaginas of the index, middle and ring fingers begin at the level of the head of the metacarpal bones and reach the distal phalanges, not connecting with the common vagina. Only the tendon sheath of the little finger connects to the vagina synovialis communis mm. flexorum digitorum manus. Action: flexes the distal phalanges of the fingers from the index to the little finger. Innervation: nn. ulnaris et medianus (C6-C8 Th1). Blood supply: muscular branches a. ulnaris.
2. The long flexor of the thumb, m.flexor pollicis longus, has the appearance of a long unipennate flat muscle lying on the lateral edge of the forearm. It starts from the upper 2/3, facies anterior radii and membrana interossea, from the epicondylus medialis humeri. The muscle passes into a long tendon, which, heading down, lies in the canalis carpi, and then is surrounded by the tendon sheath long flexor thumb, vagina tendinis m.flexoris pollicis longi, and reaching the distal phalanx, is attached at its base. Action: flexes the distal phalanx of the thumb. Innervation: n. medianus (C6-C8). Blood supply: muscular branches aa. radialis, ulnaris et a. interossea anterior.

fourth layer

The square pronator, m.pronator quadratus, is a thin quadrangular plate of transverse muscle bundles directly on the membrana interossea. It originates from the distal part of the volar surface of the ulna and inserts at the same level of the volar surface of the radius. Action: penetrates the forearm. Innervation: n. medianus (C6-C8). Blood supply: a. interossea anterior.

Lateral (radial) muscle group of the forearm

1. Shoulder muscle, m. brachioradialis, spindle-shaped, occupies the most lateral position. Slightly below its middle, the muscle passes into a long tendon. It originates from margo lateralis humeri, slightly higher than epicondylus lateralis, and from septum intermusculare brachii laterale. Heading downward, the muscle attaches to the facies lateralis radii somewhat proximal to the processus styloideus. Action: bends the arm in elbow joint and takes part in both pronation and supination of the radius. Innervation: n. radialis [C5-C6 (C7)]. Blood supply a. collateralis et recurrens radialis.
2. Long radial extensor of the wrist, m. extensor carpi radialis longus, a spindle-shaped muscle with a narrow tendon, much longer than the abdomen. In its upper part, the muscle is slightly covered by m. brachioradialis, in the distal tendon of the muscle obliquely, from top to bottom, m. abductor pollicis longus and m. extensor pollicis brevis. The muscle starts from the epicondylus lateralis and septum intermusculare brachii laterale, goes down, passes into the tendon, which, having passed under the retinaculum ex-tensorum, is attached to the base of the dorsal surface of os metacarpale II. Action: flexes the arm at the elbow joint, extends the hand and takes part in its abduction. Innervation: n. radialis (C5-C7). Blood supply: a. collaterales (a. profundae brachii) et a. recurrens radialis.
3. Short radial extensor of the wrist, m. extensor carpiradialis brevis, is somewhat covered by the previous muscle in the proximal section, and in the distal section it is crossed by the muscles passing more superficially: the abductor and extensor thumb. The muscle originates from the epicondylus lateralis humeri, ligg. collaterale and anulare radii. Heading down, it passes into the tendon, which lies next to the tendon of the previous muscle in the sheath of the tendons of the radial extensor of the wrist, vagina tendinum mm. extensorum carpi radialium, and is attached at the base of os metacarpale III. Action: unbends the hand and abducts it somewhat. Innervation: n. radialis [(C5) C6-C7]. Blood supply: a. collaterales (a. profundae brachii) et a. recurrens radialis.

Posterior forearm muscles

Surface layer

1. Elbow extensor of the wrist, m. extensor carpi ulnaris, has a long spindle-shaped abdomen and is located on the inner edge of the dorsal surface of the forearm. The muscle originates from the epicondylus lateralis humeri, margo posterior ulnae, and the articular capsule of the elbow joint. Passing into a short but powerful tendon enclosed in the tendon sheath of the ulnar extensor of the wrist, vagina tendinis m. extensoris carpi ulnaris, the muscle is attached to the base of the dorsal surface of os metacarpale V. Action: takes the hand to the ulnar side and unbends it. Innervation: n. radialis [(C6) C7-C8]. Blood supply: a. interossea posterior.
2. Finger extensor, m. extensor digitorum, has a spindle-shaped abdomen, and in the direction of the muscle bundles it has a two-pinnate shape. The muscle lies directly under the skin, closer to the lateral edge of the dorsal surface of the forearm, and borders on the ulnar side with m. extensor carpi ulnaris and with m. extensor digiti minimi, and with a beam - with mm. extensores carpi radiales, longus et brevis. The muscle originates from the epicondylus lateralis humeri, the articular capsule of the elbow joint, and the fascia of the forearm. In the middle of its length, the muscular abdomen passes into 4 tendons, which, having passed under the retinaculum extensorum, are surrounded, together with the extensor tendon of the index finger, by the sheath of the extensor tendons of the fingers and the index finger, vagina tendinum mm. extensoris digitorum et extensoris indicts, reaching approximately the middle of the metacarpal bones. Moving to the hand, the tendons are connected to each other by intermittent thin intertendinous joints, connexus intertendinei, and at the base of the proximal phalanx, from the index finger to the little finger, each tendon ends with a tendon stretch that fuses with the articular capsule of the metacarpophalangeal joint. Tendon sprains are divided into 3 legs, of which the lateral ones are attached to the base of the distal phalanx, and the middle one - to the base of the middle one. Action: unbends the fingers, also taking part in the extension of the hand. Innervation: n. radialis (C6-C8). Blood supply: a. interossea posterior.
3. Extensor of the little finger, m. extensor digiti minimi, is a small spindle-shaped abdomen, lying directly under the skin in the lower half of the dorsal surface of the forearm, between m. extensor carpi ulnaris and m. extensor digitorum. The muscle starts from epicondylus lateralis humeri, fascia antebrachii and lig. collaterale radiale and, heading down, passes into the tendon that lies in the sheath of the extensor tendon of the little finger, vagina tendinis m. extensoris digiti minimi. After leaving the vagina, the tendon connects with the extensor tendon of the fingers, going to the little finger, and is attached with it to the base of the distal phalanx. Action: unbends the little finger. Innervation: n. radialis (C6-C8). Blood supply: a. interossea posterior.

deep layer

1. Arch support, m. supinator, has the form of a thin diamond-shaped plate, located at the proximal end of the forearm from the side of its outer rear surface. The muscle originates from the epicondylus lateralis humeri, crista m. supinatoris ulnae and the articular capsule of the elbow joint, goes obliquely down and outward, covering the upper end of the radius, and is attached along it from tuberositas radii to the place of attachment of m. pronator teres. Action: rotates the forearm outward (supinates) and takes part in the extension of the arm in the elbow joint. Innervation: n. radialis [(C5) C6-C7 (C8)]. Blood supply: aa. recurrens radialis, recurrens interossea.
2. The long muscle that abducts the thumb of the hand, m. abductor pollicis longus, has a flattened two-pinnate abdomen, turning into a thin long tendon. The muscle lies in the distal half of the dorsolateral surface of the forearm and is covered in its initial part by m.extensor carpi radialis brevis and m. extensor digitorum, and in the lower section - directly under the fascia anterbrachii and skin. The muscle originates from the posterior surface of the radius and ulna and from the membrana interossea, heading obliquely downward, bends around the radius with its tendon and, passing under the retinaculum extensorum, is attached to the base of the first metacarpal bone. Action: abducts the thumb, taking part in the abduction of the entire hand. Innervation: n. radialis [C6-C7 (C8)]. Blood supply: a. interosseae posterior et anterior.
3. Short extensor of the thumb m. extensor pollicis brevis, located in the lower part of the forearm along the lateral edge of its dorsal surface. The muscle starts from membrana interossea, facies dorsalis radii and crista ulnae, goes obliquely down, lying next to the tendon m. abductor pollicis longus. The tendons of these two muscles are surrounded by the sheath of the tendons of the long abductor muscle and the short extensor of the thumb, vagina tendinum mm. abductoris longi et ex-tensoris brevis pollicis. Passing under the retinaculum extensorum, the muscle attaches to the base of the dorsal surface of the proximal phalanx of the thumb. Action: unbends and slightly abducts the proximal phalanx of the thumb. Innervation: n.radialis [С6-С7 (C8)]. Blood supply: a. interosseae posterior et anterior.
4. Long extensor of the thumb, m. extensor Vasa et nn. interossei M. extensor digitorum pollicis longus, has a spindle-shaped abdomen and a long tendon. It lies next to the previous muscle and starts from the membrana interossea, margo interosseus ulnae and facies posterior ulnae and, heading down, passes into the tendon, which lies in the tendon sheath of the long extensor of the thumb, vagina tendinis m. extensoris pollicis longi. Then, having rounded the I metacarpal bone and reaching its back surface, the tendon reaches the base of the distal phalanx, where it is attached. Action: extends the thumb of the hand and partly abducts it. Innervation: n. radialis [(C6) C7-C8]. Blood supply: aa. interosseae posterior et anterior.
5. Extensor of the index finger, m. extensor indicis, has a narrow, long, spindle-shaped abdomen, located on the dorsal surface of the lower half of the forearm, covered with m. extensor digitorum. Sometimes the muscle is missing. It originates from the lower third of the facies dorsalis ulnae, passes into the tendon that passes under the retinaculun extensorum, and together with the similar tendon of the extensor of the fingers, passing the synovial sheath, comes to the back surface of the index finger and is woven into its tendon extension. Action: unbends forefinger. Innervation: n. radialis [(C6) C7-C8]. Blood supply: a. interosseae, posterior et anterior.

Ecology of life. Cognitively: 200 muscles are included in the work with just one step. The heart, the most enduring muscle in the body, works constantly. Muscles grow and train...

200 muscles are included in the work with just one step. The heart, the most enduring muscle in the body, works constantly. Muscles grow and train, tons of sports literature have been written about them. We will tell you the most interesting.

1. How many muscles in total?

In total, there are from 640 to 850 muscles in the human body. During a simple walk, the body uses up to 200 muscles. Muscle tissue is 15% denser and heavier than fat, so a trained person can outperform a full but unathletic person of the same height in weight. Muscles account for an average of 40% of body weight.

2. The most-most muscles

The most enduring human muscle is the heart, the shortest is the stirrup (it strains the eardrum in the ear). Its length is 1.27 mm. longest muscle human body- tailor. The most fast muscle- blinking. There are different opinions about which muscle of the body is the strongest. It is often said that the most powerful muscle is the tongue, but the tongue is made up of several muscles, so this view is false. Chewing muscles are very strong (their pressure can reach 100 kilograms), as well as calves and gluteal muscles.

3. Such different muscles

Human muscles are not the same. Therefore, they need to be trained in different ways, and the recovery time and different groups muscles is different. The triceps recover the fastest, the back muscles the slowest. This must be taken into account during training, the muscles need rest no less than the load, since the growth of muscle fibers occurs due to the effect of supercompensation. Full muscle recovery occurs only 48 hours after intense exercise.

4. Muscle Endurance

Endurance - the ability of a muscle to maintain performance over time. The most enduring muscle of the human body, as we have said, is the heart. According to doctors, the "margin of safety" of the average heart is at least 100 years. Muscles begin to tire when they run out of glycogen, and fatigue is also explained big amount in muscle calcium. Previously, it was believed that the main culprit of fatigue is lactic acid. Columbia University conducted a study in which mice swam daily for three weeks and cyclists exercised for three days. It turned out that after exercise in the chemical structure of the ryanodine receptor, which is responsible for muscle contraction, there were major changes- there was a gap in the cell membrane through which calcium seeped into muscle cells.

5. Muscles and emotions

It is known that the movement of facial muscles is directly related to human emotions. At the beginning of the last century, the Russian scientist Ivan Sikorsky compiled a classification of facial expressions: the muscles around the eyes are responsible for the expression of mental phenomena, the muscles around the mouth are for the expression of acts of will, and all the muscles of the face express feelings. In 2011, scientists managed to discover that human facial expressions occur long before birth. Even during the prenatal period, the child is already able to move facial muscles, smile, raise eyebrows in surprise or frown. The facial muscles make up 25% of the total number of muscles, while smiling, 17 muscle groups are involved, during anger or crying - 43. One of better ways maintaining smooth skin on the face - kissing. With them, from 29 to 34 muscle groups work.

6. Muscles and genes

Amazingly, muscle training has an impact not only on the person himself, but also on his genes. They undergo modifications that further help the muscle fibers to be ready for new loads. In order to prove or disprove this, scientists from the University of Aarhus recruited a focus group of 20 volunteers and spent a 20-minute session with them. aerobic exercise on an exercise bike. After the study, a quadriceps biopsy was taken from the subjects to see how the genes had changed in their cells. It turned out that exercise stress activates genes related to muscles. This is because cells store DNA with the help of methyl groups. If they are removed, the gene information is converted into enzymes and proteins, which are necessary for burning calories, gaining muscle mass and oxygen consumption. After the experiment, the number of methyl groups decreased in all participants in the study - that is, the muscles adapted to an increase in metabolism.

7. Muscles and telepathy

A simple person is not able to establish control over all the muscles of the body, therefore, unconscious muscle contractions can serve as an indicator of hidden thoughts or intended actions for knowledgeable people. Psychologists high level and "telepaths" can use knowledge about these processes. Wolf Messing, one of the most famous telepaths, explained his phenomenal abilities not by magic, but by a thorough knowledge of the work of human muscles. He said: “This is not mind reading, but, so to speak, “muscle reading” ... When a person thinks hard about something, brain cells transmit impulses to all the muscles of the body.”

8. Long palmar muscle

Only one in six people on earth have long palmar muscles on both hands. Some have them on only one of their hands. These muscle fibers are responsible in animals for the release of claws. A person, of course, does not need such a function. The long palmar muscles are thus a vestige used by surgeons, if necessary, as a material for muscle transplantation.

9. Muscles and chocolate

Oddly enough, one of the most useful products for the heart and for the muscles in general is bitter chocolate. Research conducted at Wayne University in Detroit revealed the effect of the substance epicatechin contained in dark chocolate on the growth of mitochondria in muscle cells. Scientists at the University of L'Aquila also conducted a study in which they gave subjects 100 grams of chocolate for 15 days and measured their blood pressure. During the experiment, blood pressure normalized in people, blood circulation improved. Accordingly, moderate consumption of dark chocolate can be considered as a prevention of heart disease and atherosclerosis.

10. Muscle Loss

Muscles don't last forever. After 40 years, they begin to be actively burned, a person begins to lose from 2 to 3 percent per year. muscle tissue, after 60 years - up to 5%. Therefore, training in adulthood is no less important than in youth. published

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As tendon autografts, tendons are used, the taking of which does not cause significant functional and cosmetic disorders.

The tendon of the length of the palmar muscle has a significant length (from 15 to 20 cm or more, including the intramuscular part), a sufficient area cross section and strength. Its loss does not cause functional disturbances, and taking it does not cause technical difficulties.

Disadvantages of this source tendon grafts relate limited quantity plastic material, the absence of a tendon in 15% of people and sometimes its insufficient length. In this regard, the tendon of the long palmar muscle is most often used for plastic surgery of the flexor tendon on the short fingers of the hand (I and V), when only one finger is damaged. At multiple injuries fingers, it is preferable to use other sources of plastic material.

Taking technique. You can check for the presence of the tendon of the long palmar muscle if you strain the straightened fingers of the hand with some flexion in the wrist joint (Fig. 14.5.1). From a small transverse approach, the tendon is exposed at the point of transition to the palmar aponeurosis. When doing this, be careful not to damage the adjacent median nerve.

Rice. 14.5.1. Test for assessing the presence of the tendon of the long palmar muscle.

The end of the tendon is stitched and cut off, after which, when pulling on the ligatures with simultaneous palpation, it is easy to determine its course under the skin. This makes it possible to completely isolate the tendon from two additional transverse approaches to its intramuscular section (Fig. 14.5.2, a), after which it is cut off from the muscle belly. This procedure can also be performed from one access using a special tool - a tendon rasp (Fig. 14.5.2, b).

Rice. 14.5.2. Schematic representation of the approaches used to take the tendon of the long palmar muscle (explanation in the text).

Tendons of the long extensor of the II-V fingers of the foot. This source is characterized by a significant number of donor tendons (4 on each foot), their significant length (up to 25–30 cm), as well as minor loss of function and a cosmetic defect after taking.

At the same time, sometimes the tendons are not thick enough (more often on fingers IV-V), and their isolation for the entire length is technically difficult. This source of tendons is widely used in hand surgery, as well as in reconstructive operations on other segments.

Taking technique. On a bloodless segment, from short (5 mm each) transverse incisions at the level of the heads of the metatarsal bones (Fig. 14.5.3, b), the ends of the tendons of the long extensor of the II-V fingers are isolated, stitched and cut off. In this case, the tendons of the short extensor of the same fingers must be preserved.

From the next transverse approach at the level of the transverse joint of the tarsus (Shopar joint), all 4 tendons located next to each other can already be isolated. From the third longitudinal access up to 8 cm long, located immediately above the proximal edge of the ligament supporting the extensor tendons, the tendons of the long extensor muscles of the II-V fingers are exposed, which usually cannot be divided, since they represent one common trunk.

After that, the tendon sheath is carefully opened and the Rozov conductor is inserted into it in the distal direction, trying to go to the nearest incision along the surface of the extreme tendon. With the help of a conductor, each tendon is brought into the proximal wound and, thus, the common tendon trunk is separated. Then the tendons are cut off from the muscle, and after removing the tourniquet and stopping the bleeding, the wound is tightly sutured in layers (including deep fascia).

When using a tendon rasp, access to the shins is not necessary, and the procedure for taking grafts is simplified (Fig. 14.5.3, a).

Rice. 14.5.3. Accesses and stages of taking the tendons of the long extensor of the toes (explanation in the text).

For special indications, the extensor toe longus tendons can be included in the dorsal foot flap and used as vascular grafts.

The tendons of the superficial flexors of the fingers are used in plastic surgery of the tendons of the deep flexors of the fingers. Their advantages include their considerable thickness, length and quantity, as well as the simplicity of the technique of taking. According to their characteristics, they are best suited for deep tendon replacement. However, their use also has significant disadvantages.

First of all, in short-toed subjects, these tendons can be relatively short. This causes them to be taken along with the intramuscular part, after which the muscle can no longer be used, and the flexion force of the finger is markedly reduced. In addition, taking the tendons of the superficial flexors requires significant accesses, which is also disadvantageous from a cosmetic point of view.

It is important to note that this donor zone is located along the bone-fibrous canals of the fingers and therefore is the most unfavorable (in comparison with any other zones) due to the negative influence of cicatricial adhesions that inevitably form around the deep flexor tendons of the donor finger. Such a finger in the postoperative period itself requires a full rehabilitation, which may not always result in a complete restoration of function.

That is why it is advisable to use the superficial flexor tendons of only the injured finger and only when the level of injury is in the “critical” zone.

With injury at a more proximal level, the tendon graft may become too short for its effective application. Transposition of the tendon of the superficial flexor from the adjacent, longer and intact (!) finger is a gross mistake.

Taking technique. Together with the proximal end of the damaged tendon of the deep flexor of the finger, the superficial tendon is isolated from the appropriate access to the hand and brought into the S-shaped wound on the forearm. Then the tendon of the superficial flexor of the finger is isolated to the level of the muscle and cut off, after flashing its end remaining in the muscle. The latter is sutured to the central end of the deep flexor tendon after its restoration.

The tendon of the plantar muscle has a significant length and thickness, which allows it to be used in hand tendon surgery. Its disadvantage is the limited amount of plastic material, which allows using this source only for tendoplasty on one finger. In addition, the tendon is missing in 7% of people and cannot be identified before surgery.

Taking technique. From a 5-cm vertical incision anterior to the medial edge of the calcaneal tendon, the tendon of the plantar muscle is isolated and taken with a tendon rasp (Fig. 14.5.4). In this case, the instrument should pass parallel to the axis of the lower leg when unbent in knee joint limbs.

Rice. 14.5.4. Scheme of taking a graft from the tendon of the plantar muscle (explanation in the text).

The fascia lata of the thigh is a practically unlimited source of plastic material and should be rolled into a tube when replacing large tendons. Due to the fact that its surface does not have such high slip rates, flaps from the wide fascia of the thigh are not used to replace defects in the flexor tendons of the fingers.

At the same time, their transplantation can give good result when replacing other tendons, including in the form of blood-supplied grafts, including skin-fascial flaps from the outer surface
hips.

Autoplasty of tendons

The use of autotendons for tendoplasty is the most common in clinical practice. Depending on the specific conditions, five of its main options are used.

One-stage graft tendoplasty is the most common operation in which a tendon insert is sutured into a tendon defect.

In the vast majority of cases, this type of operation is performed with chronic injuries of the flexor tendons of the fingers.

Two-stage tendoplasty is used exclusively in finger flexor tendon surgery and lies in the fact that during the 1st stage of treatment, more favorable conditions are created for subsequent tendon graft transplantation.

Tendoplasty, combined with transplantation of complex skin flaps. With a combination of tendon defects with skin defects, these two problems can be solved simultaneously, since only if the tissues surrounding the tendon are in a normal state, their function can be restored.

Most often this situation occurs with injuries of the forearm in the lower third. After transplanting a complex skin flap into the defect, tendon grafts can be passed through the latter.

These two tasks can also be solved sequentially in the course of a two-stage treatment. This significantly lengthens its duration and requires repeated intervention in the same anatomical zone.

Transplantation of blood-supplied tendon grafts. When a soft tissue defect is combined with a tendon defect, blood-supplying tissue complexes, including tendons, can be used.

For this, the dorsal flap of the foot, taken with the tendons of the long extensor of the II-V fingers, can be used. Tissue complexes from the outer surface of the thigh may include a wide fascia, flaps of which can replace tendon defects.

Transposition of tendons is one of the methods for replacing tendon defects, when a nearby tendon is used for this, the muscle of which can be switched to a new function without significant functional loss. Most often, one of the paired tendons adjacent to the defect zone is used (superficial and deep flexor tendons, common and intrinsic extensor of the II and V fingers).

IN AND. Arkhangelsky, V.F. Kirillov