Tendon grafting using Gracilis and semitendinosus tendons for extensive flexor tendon defects following synovial sarcoma excision: A case report

Soft-tissue sarcomas of the hand are rare. Wide excision often causes functional impairment. Reconstructing extensive flexor tendon defects after tumor excision is challenging because suitable donor tendons with adequate length and diameter are limited. We report a 39-year-old female with synovial sarcoma on the volar wrist. Tumor excision resulted in multiple flexor digitorum profundus (FDP) tendon defects. We used gracilis and semitendinosus tendons from the ipsilateral lower limb for reconstruction. The gracilis tendon reconstructed the index finger FDP. The semitendinosus tendon reconstructed the middle, ring, and little finger FDP tendons. At one year postoperatively, the patient showed satisfactory functional outcomes. The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 4.5 points. This case suggests that gracilis and semitendinosus tendons are effective alternative autografts for extensive flexor tendon reconstruction. They provide adequate length and diameter with minimal donor site morbidity.