- 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
- 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