Extensor tendon gap reconstruction: a review

Background: The extensor tendons of the hand are located in a superficial position on the dorsal aspect of the hand and are highly susceptible to injury. Laceration, crush and avulsion injuries are common extensor tendon injuries presenting for acute care. Such injuries that involve tendon loss or gaps in the extensor tendons require specialised attention and can be some of the most challenging to repair, as extensor tendons have less excursion than flexor tendons. Reconstructive techniques for such defects may differ according to the location of the defect, especially in Verdan's extensor zones 1-5. Adequate repair of extensor tendon defects in zones 1-5 is especially important because (a) even a 1 mm tendon gap in those zones may cause 20 degrees extension loss, and (b) shortening of the extensor tendon by as little as 1 mm may cause decreased finger flexion. Review: This article reviews and discusses the literature on the various approaches and techniques for extensor tendon reconstruction, delineated by zone of injury (zones 1-8). Conclsions: Awareness of the various techniques available to repair defects in each zone of injury is important so that surgeons can choose the technique most in alignment with the type of injury, the surgeon's skills, and patient characteristics, and optimise the repair of such injuries.