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Lies et al. Plast Aesthet Res 2019;6:18 I http://dx.doi.org/10.20517/2347-9264.2019.27 Page 3 of 9

Figure 1. Analysis of defect and indicated reconstruction options

review of existing literature. We compared immediate vs. staged tendon reconstruction with evaluation of
functional outcomes for evidence-based decision making.

METHODS
Identification of Relevant Literature - Database search: The authors performed a systematic search of the
literature using the MEDLINE database (1969 through 2017) to identify articles that included the following
keywords: “extensor tendon reconstruction”. To ensure adequate coverage, the authors utilized a Boolean
search for keywords: [(hand OR extensor tendon) AND (“ROM” OR ROM OR grip strength OR patient
outcome OR return to work OR disability)]. The abbreviation of ROM was used to assess and locate
abstracts that included that term.

Search Limits: The pool of citations was then limited to those relevant to humans and published in English.
The authors limited the results to exclude case reports. Inclusion criteria required objective measurements
of data analysis including: ROM, grip strength, and patient outcomes related to return to work or disability.
Amputation and arthrodesis were accounted for as a confounding factor and excluded when elucidated.
The review of MEDLINE using these limits and search terms identified seven reliable studies, which
represented 61 patients. Data points extracted were patient demographics, surgical technique, timing of
tendon reconstruction, outcomes, and complications.

Flap types recorded included primary pedicle and free flaps with/without tendinous components vs.
staged tendon grafts. Results of metacarpophalangeal total active motion, days to max ROM, grip
strength, complication rate, number of operations, and percent returning to work were compared between
immediate vs. staged techniques and pedicled vs. free flap repairs using a two-sample t-test assuming
unequal variances. The authors adhered to the Preferred Reporting Items for Systematic Reviews and Meta-
Analyses guidelines.

RESULTS
Sixty one patients analyzed in this review included males and females ranging in age from 13 to 70 who
had undergone either an immediate 50 or staged 11 tendon reconstruction surgery. Of the fifty immediate
(single) surgery group, 39 were free flaps and 11 were pedicled. In the eleven staged group, 6 were free and
5 were pedicled flaps [Table 1].

The most reported single-stage cutaneous tendinous flaps include radial forearm and the dorsalis pedis flap.
Comparisons of outcomes [Table 2] showed immediate reconstruction had significantly fewer operations,
1.5 vs. 5.2 (P < 0.001) and led to faster return to maximum ROM 214 vs. 551 days (P < 0.001). Concurrently,