Extensor Tendon Lacerations: Zone VI: (dorsum of hand)

- See:
- Discussion:
    - if the laceration occurs proximal to the junctura the diagnosis of an extensor tendon laceration can be missed;
            - have the patient extend the affected proximal phalanx w/ the remaining digits flexed;
    - lacerations of middle or little digits proximal to junctura;
            - finger extension of these digits still may exist thru ring finger junctura tendinae contributing to distal ends of cut tendons of middle or little digits;
    - visualization is facilitated by longitudinally extending the wound;
    - the proximal and/or distal tendon edges can be opposed by transfixing needles;
    - tendon defects greater than 1 cm should not be directly opposed, since this will lead to loss of finger flexion;
            - consider intercalary tendon graft when appropriate;
    - sutures are repaired w/ a single 4-0 Ethibond modified Bunnel Weave w/ sutures and knot placed in the mid-substance of the tendon, in order to prevent tendon bunching up and tendon shortening;
    - soft tissue defects can usually be handled w/ mobilization of the pliable dorsal skin envelop;
    - Reverse Kleinert Splint:
            - wrist is held in 30 deg of extension, and MP joints are passively held in extension allowing active flexion of digits;
    - Lacerations Over the Wrist:
            - associated w/ injury to retinaculum, leading to postoperative adhesions of the retinaculum to the tendon;
            - it is controversial as to whether the extensor retinaculum should be partially resected over the repaired tendon

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, September 21, 2012 12:18 pm