Staged extensor tendon reconstruction in the finger.

Staged extensor tendon reconstruction using a silicone implant followed by tendon grafting was done to restore proximal interphalangeal (PIP) joint extension in 6 fingers with severe injuries to the dorsal skin and extensor mechanism. Abrasions to the joint capsule and cortical surfaces were also present. To avoid finger stiffness, the reconstruction was delayed and range of motion exercises were initiated early. The skin injury was managed by split-thickness skin grafting or allowed to heal by secondary intention to avoid prolonged immobilization. During surgery, the peritendinous fascia of the extensor tendon is used to guide insertion of the implant, and it serves as a premade tunnel that appears to aid the gliding and stability of the implant and subsequent tendon graft. Active extension of the PIP joint was restored in all fingers; there was an average extension lag of 15 degrees. PIP joint flexion averaged 95 degrees. On the basis of this experience, the author believes the technique to be a reliable treatment alternative for severely injured fingers with extensor mechanism loss.