Neglected Zone VII Extensor Tendons Reconstruction with a Palmaris Longus Tendon Autograft

Background: This study reported a case of zone VII multiple neglected extensor tendons reconstruction with a palmaris longus tendon autograft in a 15-year-old boy 3 months after the initial trauma. Case presentations: Preoperative examinations revealed complete damage of the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), abductor pollicis longus (APL), and partial injury of the extensor pollicis brevis (EPB). The extensor tendons were reconstructed with a palmaris longus tendon autograft combined with graft tunnel reconstruction within the scar at the level of the damaged retinaculum. After the surgical treatment, short immobilization and early rehabilitation were applied, providing passive sliding of the reconstructed tendon supplemented with actively mediated extension. Results: Despite the neglectful nature of the injury, surgical treatment and early postoperative rehabilitation resulted in an excellent functional outcome. At the follow-up visit, 6 months postoperative, the patient presented a full range of motion of the radiocarpal joint and thumb without any limitations on hand function. Conclusions: (1) Palmaris longus tendon autograft is a viable option for the treatment of multiple zone VII extensor tendon damage. (2) The combination of early passive motion and actively mediated extension provides tendon gliding and results in good functional outcomes for a hand with zone VII extensor tendon injury. (3) Ultrasound examination can evaluate early results and detect complications, mainly tendon/graft adhesions, after extensor tendon reconstruction surgery.