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Lies et al. Plast Aesthet Res 2019;6:18 Plastic and
DOI: 10.20517/2347-9264.2019.27 Aesthetic Research

Original Article Open Access

Review of the optimal timing and technique for
extensor tendon reconstruction in composite dorsal

hand wounds

Shelby Lies , Asher Horowitz , Gordon Lee , Andrew Y. Zhang 1
1
1
2
1 Department Plastic Surgery, University Texas Southwestern, Dallas, TX 75390, USA.
2 Department Plastic Surgery, Stanford University, Palo Alto, CA 94304, USA.

Correspondence to: Dr. Shelby Lies, Department Plastic Surgery, University Texas Southwestern, 1801 Inwood Road, Dallas, TX 75390-
9132, USA. E-mail: Shelby.Lies@UTSouthwestern.edu

How to cite this article: Lies S, Horowitz A, Lee G, Zhang AY. Review of the optimal timing and technique for extensor tendon reconstruction
in composite dorsal hand wounds. Plast Aesthet Res 2019;6:18. http://dx.doi.org/10.20517/2347-9264.2019.27
Received: 3 Jun 2019 First Decision: 22 Jul 2019 Revised: 23 Jul 2019 Accepted: 25 Jul 2019 Published: 9 Aug 2019

Science Editor: Matthew L. Iorio Copy Editor: Jia-Jia Meng Production Editor: Tian Zhang

Abstract

Aim: The management of complex dorsal hand wounds with extensor tendon loss is controversial. Treatment has
focused on soft tissue coverage, but there is limited evidence comparing immediate vs. staged tendon reconstruction.
This review evaluates existing literature to determine the optimal management of composite hand defects.

Methods: A MEDLINE database review was performed including objective measurements such as number of operations,
total active motion, grip strength, days to maximum range of motion (ROM), and return to work. Data extraction included
demographics, surgical techniques, complications, and relative outcome. We compared primary and secondary staged
reconstruction to correlate any significant differences in outcome and determine optimal timing and technique for
extensor tendon reconstruction. We extracted information on flap types including regional and free tissue transfer with
tendinous components vs. staged tendon grafts.

Results: Comparison of outcomes showed that patients with immediate reconstruction had fewer operations, faster
return to maximum ROM, and greater chance of returning to work. The most successful single stage flaps include the
radial forearm, suitable for reconstructing one to three tendons and the dorsalis pedis for three or four tendons; however,
there were significantly more complications in immediate reconstruction particularly regarding donor site morbidity.
Pedicled flaps had better total active motion. The two-stage approach resulted in acceptable functional outcomes
without significant complications.

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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