Two-stage extensor tendon graft using the Paneva-Holevitch procedure: A new technique

Area of Science:

• Hand surgery
• Orthopedic surgery
• Reconstructive surgery

Background:

• Reconstructing extensor tendons is challenging due to donor site morbidity and limited graft availability.
• Current methods like tendon transfers and grafts have inherent drawbacks.

Observation:

• A new technique involves anastomosing the extensor indicis proprius tendon to the extensor digitorum tendon in the index finger.
• The extensor digitorum tendon is then advanced distally after transection in the forearm.
• Feasibility was assessed in 6 cadavers (12 upper limbs), with successful tendon advancement to the proximal interphalangeal joint.

Findings:

• The mean usable graft length achieved was 13 cm (range: 9.7-15.2 cm).
• The technique was successfully applied in a clinical case of a 24-year-old patient with extensive extensor apparatus destruction.
• The clinical outcome was excellent, demonstrating the technique's efficacy.

Implications:

• This method offers a simple, consequence-free alternative to traditional tendon grafts by utilizing existing, already divided tendons.
• It preserves donor sites and overcomes graft stock limitations.
• This technique represents a valuable addition to the reconstructive surgeon's armamentarium for extensor tendon injuries.