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

Figure 3. Pedicled composite radial forearm flap with tendon orientation upon transposition

Anterior lateral thigh and lateral arm perforator flaps are considered ideal for coverage of dorsal hand
soft tissue defects with minimal donor site morbidity [30,31] . Due to the varying presentation and degree
of severity of these complex injuries, there is vast heterogeneity in the surgical management depicted.
Lack of structured data collection and inconsistency in reporting outcomes limits the conclusiveness of
retrospective literature review.

Tendon graft is the most common reported staged reconstruction technique; if significantly delayed,
myostatic contracture may necessitate a tendon transfer for adequate power. We do acknowledge the
variable postoperative protocols and compliance with therapy regimens with retrospective reviews.
Early active motion is favored with the lowest rate of extensor lag, averting the need for tenolysis after
static splinting. Fortunately, tendon rupture is rare [32,33] . Available evidence suggests better outcomes
with dynamic over static splinting after repair of extensor tendons in Zone V-VIII of the hand [34,35] . Early
[36]
mobilization after tendon transfers is also safe and beneficial in the initial rehabilitation phase .
Review of the literature for reconstruction of extensor hand defects provides us with a myriad of different
procedural modalities to choose from. The present review was limited by lack of consistent objective
measurements. Scrutiny in criteria of data collection refined the specificity and increased the reliability of
evidence to draw from. Decreased sensitivity lowered the power of the study; particularly lacking data on
staged reconstruction and elicitation of complications. The significantly less operations and earlier time
to maximum ROM provide a basis to support and favor the use of single-stage reconstruction. By effect,
immediate cutaneous tendinous reconstruction allows for expedited recovery and quicker return to work.
These factors correlate with significant decreases in cost and saved productivity for quality of life. Pedicled
composite radial forearm flap showed the best potential for total active motions, earlier recovery, and least
complications and can include modifications of slips for tendon repair coaptation [Figure 3].

The staged approach nonetheless resulted in acceptable functional outcomes. Choice of staging tendon
reconstruction can be justified in certain cases dependent on patient condition and preference.

The algorithm in Figure 4 provides some guidance in choosing the best individualized plan for this
challenging problem.