Palmaris longus tendon as an autogenous expander for Brown's syndrome: A novel technique

IntroductionThe palmaris longus tendon (PLT) is one of the most commonly used donor tendons in orthopedic and reconstructive surgery. We present a new surgical technique using this autogenous tissue for lengthening the superior oblique tendon in cases of moderate to severe Brown syndrome.MethodsFour children with Brown syndrome were selected, and consent was obtained. Preoperative motility assessment and intraoperative forced duction tests confirmed the diagnosis. PLT harvesting was performed under general anesthesia. Follow-up ranged from 12 to 21 months.ResultsPreoperatively all patients demonstrated hypotropia of 16Δ to 30Δ with an abnormal head posture. Postoperatively all patients showed an improvement in hypotropia to <3Δ, with complete resolution of abnormal head posture. Improvement of elevation in adduction did not match that of the vertical deviation, but all patients had less restriction of elevation in adduction after surgery. No patients developed any of the complications encountered with a silicone expander (eg, extrusion, tendon-related inflammation, foreign body sensation, or consecutive superior oblique palsy), and none needed further surgery. Wrist function was completely normal in all patients postoperatively.ConclusionsPLT is an autogenous tissue that allowed for controlled weakening of the superior oblique tendon, with minimal complications observed in four patients. More studies comparing PLT tendon expansion with other published methods are warranted.