When to use vascularized tendon transfers and how is the digital flexion sliding system supposed to work?

In classes III, IV, or V of Boyes’ classification are patients who have already undergone multiple operations with skin scarring, joint stiffness and severe flexion contracture deformity.

Treatment of such problems has consisted of amputation, distal arthrodesis or tendon grafting, often in two stages. The latter approach, however, allows neither adequate nutrition to the graft (leading to repeated failures) nor results in consistently satisfactory function, and even then, the ultimate range of active movement requires a minimum of 6 months to achieve.