title: Reconstruction of a functional gliding surface with extensor retinaculum in extensor tendon reconstruction in the digits.
abstract: BACKGROUND
  Tendon gliding is key to optimal recovery of hand function after complex tendon injuries. Gliding is facilitated by a low-friction gliding surface that is normally provided by the periosteum of the underlying bone. However, significant injuries may damage the periosteum, which must be reconstructed to allow uninterrupted tendon excursion. The absence of the periosteum may compromise a tendon's ability to glide freely, thereby limiting the range of motion.
  
  
  METHODS
  Six digits in 4 patients with complex, composite soft tissue defects involving tendon, periosteum, and skin of the hand underwent surgical repair. Each digit had disruption of the bony cortex underlying the tendon injury including periosteal loss. Through an incision on the dorsum of the ipsilateral wrist, an extensor retinaculum graft corresponding to the size of the periosteal defect was harvested. It was then sutured into place over the bare cortex to replace the lost periosteum.
  
  
  RESULTS
  All the 6 digits in the 4 patients had complete return to function. Additionally, all patients had near normal strength in the repaired hand along with excellent tendon excursion in both flexion and extension. The average time of follow-up of this series of patients was 1.5 years.
  
  
  CONCLUSIONS
  Extensor retinaculum grafting to replace lost periosteum is a technique that is easily used, uses locally available autogenous tissues, and produces excellent tendon function. Additionally, the histologic similarities between extensor retinaculum and periosteum add scientific merit to this novel approach. On the basis of our experience, we recommend the use of extensor retinaculum for periosteal reconstruction to provide an adequate gliding surface for a reconstructed tendon.
authors.affiliation: From the Institute of Reconstructive Plastic Surgery, Department of Plastic Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Barr
authors.forename: Lisa
authors.initials: L
authors.lastname: Schneider
authors.forename: Sheel
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000328:Adult; D005383:Finger Injuries / Q000601:surgery*; D005384:Finger Joint / Q000502:physiology / Q000601:surgery; D006801:Humans; D008022:Ligaments / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D010521:Periosteum / Q000293:injuries* / Q000601:surgery; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D017695:Soft Tissue Injuries / Q000601:surgery*; D013708:Tendon Injuries / Q000601:surgery*; D014182:Transplantation, Autologous / Q000379:methods; D014953:Wrist; D055815:Young Adult