Two-stage Reconstruction of Hand Extensor Tendons Using Silicon Rods

Abstract

Summary: The extensor system of the hand is an intricate complex component that involves a working balance between the extrinsic and intrinsic muscles of extension. Injuries to the extensor tendons are typically repaired primarily or by tendon transfers or grafts at a second stage. A 16-year-old boy sustained a right hand crush injury following an all-terrain vehicle accident, resulting in the loss of dorsal skin and extensor tendons of digits 3, 4, and 5 involving extensor zones 4–6, and oblique fractures in the second and third metacarpal bones. Primary surgery involved fixation of aforementioned fractures utilizing K-wires along with superficial circumflex iliac artery flap coverage for the raw areas post debridement. Following this, primary extensor tendon reconstruction was performed using silicon Hunter rod implants and autologous tendon grafts via a two-stage approach. Over a 2-year postoperative period, the patient demonstrated active functional extension of all four fingers with some limitations to range of motion. This case report supports the hypothesis that the pseudo-synovial sheaths created by silicone rod implants assist the easy gliding motion of tendon grafts in the second stage of reconstruction, reducing the risk of tendon adhesions, shortening, and extension lag.

“Free chimeric SCIAP flap in reconstructing the distal complex extensor tendon injury.”

“…A two-stage procedure to restore tendon continuity with tendinous graft followed by initial resurfacing has been the prevailing option, but the staged approach has been associated with donor-site morbidity. 16,17 Key to this reconstructive procedure is the reattachment of extensor tendon insertion; if this is not performed, the fused or unstable interphalangeal joint may result in stiffness or instability. Although fixation with the suture anchor is workable, it is not preferred because of its additional cost.…”

“…A two-stage procedure to restore tendon continuity with tendinous graft followed by initial resurfacing has been the prevailing option, but the staged approach has been associated with donor-site morbidity. 16,17…”