A modified technique of two-staged extensor tendon reconstruction in zones 6–8 in a patient with absent palmaris/plantaris tendons: A case report

Abstract

HighlightsWe encountered a patient with major defects of the extensor tendons.The patient had no palmaris or plantaris tendons.A modified technique of two-staged extensor tendon reconstruction was used.We utilized the split flexor carpi radialis as the tendon graft.At final follow up, there was full active extension of the fingers.

Two-stage Reconstruction of Hand Extensor Tendons Using Silicon Rods

“…The use of silicone rods helps minimize the risk of adhesions that result from fibrosis in the healing process that follows immediate tendon transfer with open contaminated soft tissue defects, allowing the creation of a highly vascularized pseudo-synovial sheath that maintains a tunnel between the forearm and fingers. 1 , 3 , 6 , 7 The pseudo-synovial sheath is formed of three layers: an intima, media, and adventitia, forming an excellent gliding surface for tendon grafts. The intima secretes glycosaminoglycan substances, while the media is made of collagen and provides structural and vascular support and the adventitia is a highly vascularized structure composed of loose fibrous tissue.…”

“…This reduces the risks of tendon adhesions, shortening, and rupture, which are often reported in cases of extensive soft tissue trauma to the dorsum of the hand, accompanied with extensor tendon loss. 1 , 3 , 7 , 5 …”

Tendon Reconstruction With Cadaveric Allograft in a Patient With Flexor Tendon Injury Without Treatment for Six Months

“…As stated before, the placement of the silicon spacer allows the creation of a synovial pseudo-sheath around it, with intima, media, and adventitia layers. These provide vascular nutrition, functional and structural support for the tendon graft to be placed afterward [ 13 ]. This synovial pseudo-sheath provides multiple benefits such as allowing for proper gliding of the tendon and minimization of the risk of adhesions [ 13 ].…”

“…These provide vascular nutrition, functional and structural support for the tendon graft to be placed afterward [ 13 ]. This synovial pseudo-sheath provides multiple benefits such as allowing for proper gliding of the tendon and minimization of the risk of adhesions [ 13 ]. However, an alternative is the reconstruction of the synovial sheath by using flaps of various origins, such as the dorsal podium, the fascia lata, or the temporal fascia; however, the drawbacks of this technique include morbidity at the donor site, higher likelihood of the patient not consenting to such procedure, and low availability of donor sites [ 13 ].…”

Surgical Technique for Harvesting ECRL and ECRB Concurrently as Upper Extremity Tendon Autograft

“…F or tendon and ligament reconstruction, the 2 available resources are allograft and autograft tendons. [1][2][3] Allografts are commercially available and are easy to use since they do not require a separate harvesting procedure. However, their cost, possible foreign body reaction, and, although remote, very real possibility of infectious disease transmission are concerning.…”