Two-stage extensor tendon graft using the Paneva-Holevitch procedure: A new technique

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

“…Free flap options include the radial forearm flap (which includes the palmaris longus or the flexor carpi radialis tendons), the dorsalis pedis flap (which includes the toe extensors), and thigh flaps (which include the fascia lata) [9,10]. In contrast, major defects of the extensor tendons over zones 6–8 in the presence of good soft tissue coverage is a rare entity; explaining the few reported cases in the literature [[3], [4], [5], [6], [7]]. In these cases, the overlying skin/subcutaneous tissue is always scarred; and hence two-staged reconstruction is preferred.…”

“…Generally, the best motor tendon is the original proximal cut ends of the extensor tendons in the forearm [3,4,7]. However, if the tendon defects include the musculotendinous junctions; another motor tendon is chosen.…”

“…The best choice of tendon grafts has always been the palmaris/ plantaris tendons [[3], [4], [5], [6], [7]]. In our case, these tendons were absent; and hence we used the split flexor carpi radialis tendon as the tendon graft.…”

“…In contrast, two-staged extensor tendon reconstruction is a rare entity and is mainly indicated for major defects of the extensor tendons in zone 6; and requires the presence of supple metacarpophalangeal joints and the presence of adequate soft tissue coverage at the injury site. A review of the literature showed only 14 reported cases of two-staged extensor tendon reconstruction [[3], [4], [5], [6], [7]]. In the first stage a silicone rod is inserted; and the rod is then replaced by palmaris longus/ plantaris tendon graft in the second stage.…”