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Page 12 of 25 Bertolini et al. Plast Aesthet Res 2023;10:34 https://dx.doi.org/10.20517/2347-9264.2022.121

Figure 4. Zone 2: local tendon flap.

For zone 1-5 reconstructions, the finger is typically immobilized in extension for 4 to 6 weeks, sometimes
performing a K-wire temporary arthrodesis of the interphalangeal joint. On the other hand, for zone 6-8
reconstructions, early passive and active motion could be permitted [59,98] .

Sagittal bands reconstruction
The sagittal bands (SBs) at the metacarpophalangeal (MC) joints act as the primary lateral stabilizers of the
extensor tendons. Although trauma is the most frequent cause, congenital, inflammatory, or degenerative
[99]
processes can also lead to extensor tendon subluxation .
In order to center the extensor digitorum communis (EDC) tendon over the MC joint and regain strength
with range of motion, several techniques have been described and advocated in the literature. In the case of
acute injuries, conservative treatment with Yoke splint and immediate controlled active motion (ICAM) can
be effective. The surgical treatment options depend on the local tissue quality: if the sufficient quality of the
injured tissue remains, direct repair with realignment is possible, but if there is a sagittal band loss of
substance, various forms of reconstruction should be considered [99-101] . The main reconstructive options
include flaps from extensor tendon (e.g., rotational tendon flap inserted to the adjacent finger volar plate as
an anchor site), the use of juncturae tendinum to lengthen the EDC tendon graft , and palmaris longus
[46]
tendon graft .
[99]