[Reinterventions after surgery of the extensor tendons].

Tenolysis, tendon grafts or tendon transfer are the main procedures to be considered for secondary repair in zone 6. Tenolysis is also indicated when adhesions prevent gliding in zone 5. Here interposition of the extensor retinaculum may provide protection against deep scar tissue. In zone 4, particularly in the presence of supernumerous tendons of abductor pollicis longus, mismatching of tendon ends may have occurred. In such cases the right connections have to be reestablished. Lesions of the hood which have not been recognized primarily will sometimes, when causing dislocation of the extensor tendon over the metacarpal head, be an indication for secondary repair of the hood and adhesions in this region for tenolysis or tendon lengthening. Button-hole deformity following primary repair for lesions of the extensor apparatus in zone 2 has the same indications for repair as old untreated lesions. From the many methods recommended to deal with this difficult lesion the author prefers the FOWLER, MATEV, and PIEPER procedures. Failure after primary repair in zone 1 due to rupture of the extensor apparatus calls for either secondary suture, some form of tendon-plasty or a PULVERTAFT tenorrhaphy.