Extensor Tendon Reconstruction

The reconstruction of the extensor mechanism is not as simple as flexor tendon reconstruction because of the complex nature of the anatomy and kinesiology particularly within the finger. The reconstruction of the long extensors is straightforward involving either tendon buddying, tendon grafting or tendon transfer with a reasonably predictable result. The reconstruction of the extensor mechanism in the finger is far harder and much less predictable. It should always be remembered that the purpose of the hand is to hold onto objects and manipulate them. The worst thing a surgeon can do to someone’s hand is to interfere with that function and in attempting reconstruction of the extensor mechanism cause loss of flexion and so inhibit that vital function. In some situations, for example in the burnt hand, the amount of fibrosis may act as a form of elastic recoil such that attempts at extensor tendon reconstruction may be futile and inappropriate. Realistic goals are vital in this area of reconstructive surgery. Therefore it is important that the function of the hand is assessed properly by an experienced hand therapist and the surgeon should discuss with the therapists what the realistic objectives are. Far too often surgeons do surgery that may satisfy their own objectives but fail to reach the patients expectations.