Neglected but Negotiated - A Case Report of Multiple Zone VII Extensor Tendon Injuries Reconstructed Using Fascia Lata Autograft.

INTRODUCTION: Extensor tendon injuries of the hand are frequently encountered owing to their superficial anatomical position and inadequate soft tissue protection [1]. When such injuries are neglected, particularly at the level of zone VII, they present substantial reconstructive challenges due to tendon retraction, fibrosis, adhesion formation, and increased tendon gaps. Multiple reconstructive strategies have been described in the literature, with tendon grafting being a dependable option in delayed presentations [2].

CASE REPORT: We describe a case of a 2-month-old neglected zone VII extensor tendon injury of the right hand following a glass-cut trauma. The patient presented with an inability to actively extend the index and middle fingers. Intraoperatively, complete transection of the extensor digitorum communis (EDC) and extensor indicis proprius tendons of the index finger, complete transection of the EDC tendon of the middle finger, and partial transection of the EDC tendon of the ring finger were identified, with an approximate 11 cm tendon gap. Reconstruction was achieved using a fascia lata autograft to bridge the defect. Postoperative care included brief immobilization followed by early controlled mobilization, resulting in satisfactory functional recovery.

CONCLUSION: Reconstruction using a fascia lata autograft represents a reliable and effective method for managing neglected multiple extensor tendon injuries in zone VII. The presence of juncturae tendinum may clinically obscure complete tendon disruption. Even within a short duration after injury, the tendon may not be amenable to primary repair and may require grafting. Structured early rehabilitation remains critical for achieving optimal functional outcomes [3].