PMC2938636_01
Wound appearance two days after initial debridement
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At scheduled review two days later, there was residual soft-tissue erythema and induration, and small amounts of purulent discharge at the incision sites [Figure 1].
Intraoperative findings at repeat debridement showing multiple ruptured extensor tendons. Tendon ends were frayed and necrotic
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All tendon stumps were necrotic and frayed [Figure 2].
Intraoperative wound appearance prior to tendon reconstruction. Superficial skin necrosis is seen to involve the proximal half of the bipedicled skin bridge
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One week later, infection resolved [Figure 3] and he underwent reconstruction with a free doubled-over palmaris longus (PL) bridge graft.
Extensor tendon reconstruction with folded-over PL graft. Proximal attachment to common extensor bundle of index, middle and ring finger. Distal attachment to EIP and EDC of index finger (radial limb) and EDC of middle and ring finger (ulnar limb)
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The two distal ends found attachment to the distal ends of right EIP and EDC to the index finger (radial limb), and EDC to the middle and ring fingers (ulnar limb) [Figure 4].
Folded-over palmaris longus graft tunneled deep to extensor retinaculum
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The PL graft was tunneled under the extensor retinaculum [Figure 5] to buffer the repair and enhance gliding.
Appearance at 6 months after tendon reconstruction
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At 6 months, all wounds had healed and there was no evidence of recurrent infection [Figure 6].