Reconstruction of zone 2 extensor tendon defects with split-thickness turn-down flap: A new technique

Reconstruction of tendon defects is a challenge for hand surgeons. Tendon autografts can be used to repair these defects but can cause donor site morbidities. Although turn-down tendon flaps were described for the reconstruction of tendon defects in the lower extremity, there is not enough knowledge regarding the upper extremity. This study investigated the outcomes of reconstruction of zone 2 extensor tendon defects with turn-down extensor tendon flap. Seven fingers of six patients with zone 2 extensor tendon defects treated with the turn-down extensor tendon flap technique were retrospectively evaluated. Patients' demographics, mechanism of injury, length of stay at the hospital, and complications were obtained from hospital registry records. Postoperative outcome measures in the 6th month included Michigan hand Outcomes Questionnaire scores, active, passive, and functional range of motions (ROM) at the distal interphalangeal joint (DIP). In the postoperative 6th-month follow-up, the mean passive extension and flexion ROM of the DIP joint were 4.4 ± 0.9 (range, -3 to -5) and 79.2 ± 2.4 (range, 75 to 82), respectively. The mean active extension and flexion ROM of the DIP joint were 3.5 ± 1.2 (range, 2 to 5) degrees and 77.6 ± 2.8 degrees (range, 73 to 82), respectively. The mean minimum and maximum functional ROM of the DIP joint were 6.8 ± 1.3 (range, 5 to 9) and 54.8 ± 3.0 (range, 50-60), respectively. The turn-down flap technique appears to be safe and effective in reconstruction zone 2 extensor tendon defects. LEVEL OF EVIDENCE: Level IV, Case series.