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Bertolini et al. Plast Aesthet Res 2023;10:34 https://dx.doi.org/10.20517/2347-9264.2022.121 Page 13 of 25

Figure 5. Zone 3: central slip reconstruction: longitudinal division and suturing of lateral bands.

Complications
Peritendinous adhesions that form after extensor tendon repair and reconstruction remain a difficult issue.
Numerous materials have been used in order to limit adhesions, but without reproducible results and real
success. Tenolysis may ultimately be required if the functional range of motion is not obtained, even though
it should not occur before 6 months postoperatively. The patient candidate for tenolysis should be willing to
access therapy and should show these features: failed nonsurgical management for at least 6 months, full
passive range of motion, pliable and well-healed skin without strong scar tissue, and uninvolved joint
[63]
surfaces .
Arthrodesis is a feasible option for patients suffering from pain and dysfunction after failed extensor tendon
repair and/or revision in zones 1 and 3. Fusion of the joint at this level can be a reliable method to eliminate
pain while maintaining some level of function [63,102] .

Outcomes
To measure clinical outcome and patient satisfaction, Nakamura and Katsuki suggested the use of the pulp-
to-palm distance, patient satisfaction (based on the visual analog scale, VAS) and the metacarpophalangeal
(MP) joint extension lag. They found that patient satisfaction is related to the pulp-to-palm distance, but
[76]
not to the MP joint extension lag .