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

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- 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