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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 7 of 9

Figure 4. Algorithm for composite dorsal hand wound reconstruction. RRFF: reverse radial forearm flap; DP: dorsalis pedis; ALT:
anterolateral thigh

In conclusion, while this study does provide a foundation, further multi-center studies are needed to
improve power. Limitations of review include retrospective recall bias, inability to stratify cohorts, variable
compliance postoperative rehab regimens, and the lack of objective functional data measurements for
comparison between tendon graft and transfers and the need for hunter rod pseudosheath creation. When
no extensor tendon reconstruction is performed, compensatory tenodesis effect from scar contracture
may be functionally tolerable to the patient. The results of total active motion in these cases are likely not
followed. Future studies will look at prospective comparison risk/benefit Hunter rod placement, critical
lengths of nonvacularized tendon grafts, as well as a cost analysis to compute the comparative efficacy of
immediate reconstruction, particularly factoring in gain of productivity and quality of life factors.

DECLARATIONS
Acknowledgments
Paul J. Weatherby, BS and Pablo L. Padilla, MD University of Texas Medical Branch, 301 University Blvd.
Galveston, TX 77555. Paul J. Weatherby and Pablo L. Padilla, assisted with literature review data collection
and compilation.

Authors’contributions
Primary author interpretation of results and summarization: Lies S
Manuscript submission: Horowitz A
Reviewed manuscript: Lee G
Edited manuscript: Zhang AY

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.