Primary Extensor Tendon Reconstruction in Dorsal Hand Defects Requiring Free Flaps

Abstract

This study reports results in nine patients with extensive loss of soft tissue, extensor tendon, and bone, treated with an emergency free flap for skin cover, primary bone grafts, and tendon grafts passed through individual tunnels in the free flap. Four had a good result, four were fair and one poor. Six patients returned to work, two were not working and one was retired. In select patients, emergency reconstruction of severe extensor tendon injuries appears to produce better function, with fewer operations, a shorter hospital stay, minimal complications, and a shorter period of disability.

Flap coverage of dorsum of hand associated with extensor tendons injuries: A completely vascularized single‐stage reconstruction

“…Scheker et al 10 reported encouraging results in severe dorsal hand injuries with primary tendon grafts covered by a free flap from either the lateral arm or groin. The tendons used were free tendon grafts placed through a subcutaneous tunnel under the flap at the primary procedure.…”

“…36 In fact, muscle flaps are too bulky, especially in the early stages, requiring subsequent thinning, and they adhere to tendon grafts more heavily than do other flaps. 10,12 Muscle and fascial flaps offer the best aesthetic results in the donor site, which can be closed directly. In contrast, cutaneous flaps offer the best aesthetic results in the recipient area, providing skin similar to that of the dorsum of the hand.…”

“…36 Distally based radial 4 and ulnar 5 flaps sacrifice a major vascular supply to a hand, and this may jeopardize blood flow to an already compromised area. 10 The reversed posterior interosseous flap 6 offers a good cosmetic result, employing a small artery which is of secondary importance for the vascular supply of the hand. The main disadvantages are the limited dimensions of the flap harvested when the donor site is closed directly.…”

Single-stage reconstruction of skin and tendon defect of finger with dorsal metacarpal artery flap: A case report

“…Although crush and avulsion injuries are relatively rare, they often leave a tendon gap at the repair site. Particularly in zones I-V, a 1 mm tendon defect in the extensor tendons may cause a 20-degree extension loss or decreased digital flexion [3,4]. To remedy such defects in the extensor tendon, a number of techniques have been described including tendon grafts, tendon transfers, two-stage tendon reconstructions, free tendon flaps, juncturae tendinum flap, local tendon flaps, and tendon lengthening techniques [5].…”

“…Several local flap options, such as reverse cross finger flaps, homodigital island flaps, adipofascial turnover flaps, and reverse dorsal metacarpal flaps, are recommended to cover dorsal digital soft tissue defects [6][7][8][9]. When a soft tissue defect is accompanied by a tendon defect, it is usually preferred to reconstruct the missing tendon by performing primary tendon grafting, tendon transfers, and tendon lengthening techniques at the time of soft tissue coverage [4,10]. Stage reconstruction of extensor tendons utilizing a silicone rod is rare, because creation of a secondary tendon sheath is not necessary as extensor tendons are anatomically different from flexor tendons [11][12][13].…”