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Palmaris Longus Tendon Graft Harvest

- Discussion:
    - most commonly used tendon graft for the hand;
    - palmaris longus tendon is extrasynovial and does not have synovial membrane;
    - instead of synovial membrane, the tendon has a paratenon which does not promote gluiding as well as intrasynovial tendons;

- PreOp Planning:
     - determine whether palmaris longus is present w/ active opposition of thumb against the litter finger;
           - attempt to palpate the tendon, as well as, to determine the thickness of the tendon (if there is indication that the tendon is small, the patient should be consented for possible graft harvest from other areas of the body);

- Technique:
     - make transverse wrist incision;
     - spread away the areolar tissue and identify the tendon;
     - make a second transverse incision, about 8 cm above the first incision, and again identify the tendon;
     - pull on tendon from both wounds to ensure that the same tendon has been isolated in both wounds;
     - a third transverse incision can be made, even more proximally;
     - alternatively, an appropriately sized tendon stripper can be used

Boundary Lubrication between the Tendon and the Pulley of the Finger.