Reconstruction of the extensor tendon of the hand
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Please note that self-interpretation of the results is not acceptable; the information below is for informational purposes only.
Extensor Tendon Reconstruction of the Hand is a surgical procedure used to restore the continuity and function of the tendons responsible for finger and hand joint extension. It is indicated in cases of chronic injuries, tendon substance loss, or failure of conservative treatment.
The extensor tendons are located on the dorsal side of the hand and fingers and are responsible for joint extension. The extensor digitorum communis (EDC) is the main extensor tendon, with branches to each finger. These tendons are thinner and flatter than the flexor tendons and form a complex system on the back of the hand known as the extensor apparatus. Unlike flexor tendons, which are protected in bony canals, extensor tendons are more superficial and therefore more vulnerable to injury. They are essential for hand opening, object release, and precise finger positioning during fine motor tasks. Injuries such as lacerations, avulsions, or trauma can disrupt the continuity of these tendons; when primary intervention is not feasible (due to chronic injuries or tissue defects), reconstruction is performed, which may involve tenoplasty, tendon transfers, or grafts.
Extensor tendon reconstruction involves surgical techniques adapted to the anatomical area affected. Finger-level injuries require fine suturing and special attention to proper structural alignment to prevent residual deformities. Compared to flexor tendons, extensors have better vascularization, providing superior potential for spontaneous or surgically guided healing.
Purpose
Goal: To restore tendon continuity and function for regaining finger extension.
Main components:
- Assessment of the injured area (Verdan zones I–VIII)
- Choice of technique: direct suturing, tenoplasty (mobilization of lateral bands), tendon transfers, grafts (autografts from palmaris longus/superficial flexor tendon)
- Subsequent immobilization and rehabilitation
Function
- Restores extension of the affected joint
- Prevents deformities such as mallet finger, boutonnière, or extensor lag
- Allows restoration of finger and hand functionality
Indications
- Lacerations with significant tendon defect – over 50% of tendon thickness or partial ruptures with marked strength loss (compared to the contralateral forearm)
- Injuries involving adjacent tissue loss – skin defects, joint perforation, or bone fractures affecting the tendon
- Delayed presentation (>6–7 days) after acute injury directly to emergency care – or when debridement is required, followed by delayed primary reconstruction
- Segmental defects or extensive zones (Zones VI–VIII) – where two-stage reconstruction or tendon graft/autograft may be needed to restore length and function
- Persistent dysfunction after conservative treatment (>6 months) – postoperative delays with functional restrictions may require reoperation, such as tenolysis or tendon release
Patient Preparation
- Clinical and imaging evaluation (X-ray to rule out fractures/avulsions)
- General medical check-up, consent, and possibly blood tests
- Anesthesia (local or regional in most cases, general anesthesia if deep relaxation is needed)
Procedure
The procedure involves making an incision to expose the injured tendon, followed by cleaning, alignment, and direct suturing or reconstruction with a tendon graft/transfer, depending on injury severity. The intervention is performed under local, regional, or, rarely, general anesthesia and takes approximately 1–2 hours. Postoperatively, the hand is immobilized in extension for 3–6 weeks, depending on the affected area and type of reconstruction performed.
Recovery after extensor tendon reconstruction is essential for the complete restoration of hand function. Immediately post-op, immobilization in a functional extension position is recommended for 3–6 weeks, followed by a physical therapy program supervised by a specialized therapist. Strict adherence to the rehabilitation schedule and activity restrictions is crucial for optimal outcomes.
Extensor tendon reconstruction is critical for restoring extension function in chronic or complex cases, involving surgical techniques tailored to the site of injury.
Sources:
https://openorthopaedicsjournal.com/VOLUME/6/PAGE/36/FULLTEXT/?utm_source=chatgpt.com
https://pmc.ncbi.nlm.nih.gov/articles/PMC3377907/
https://www.sciencedirect.com/science/article/abs/pii/S0363502301700457
https://www.orthobullets.com/hand/6038/extensor-tendon-injuries
IMPORTANT!
It is very important to note that the information in this section is not intended for self-diagnosis or self-treatment. If you are experiencing pain or a worsening of a medical condition, you must consult a doctor for diagnostic investigations. Only a qualified specialist can provide an accurate diagnosis and determine the appropriate treatment.
To obtain the most precise and consistent analysis results, it is recommended to perform your tests at the same laboratory. This is because different laboratories may use different methods and measurement units for similar investigations.
