A 40-year-old male who suffered a traumatic injury on the dorsum of the right hand after being hit by a tendon on a treadmill, presented an important lesion of the extensor muscle-carrier skin union and myotendinous junction.
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In a first emergency surgical procedure, exhaustive cleaning, wound closure and antibiotic coverage were performed, postponing reconstructive surgery due to the high risk of infection.
After one week and despite prophylactic measures, the wound suffered an infection by anaerobic microorganisms that was treated with surgical debridement, antibiote and hyperbaric chamber for three weeks.
Once the infection was resolved, it was programmed for tendon transfer, but during the surgical procedure necrosis of the extensor tendons was found, so it was decided to resect to viable tissue and use silicone rods with a posterior tendon.
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One month after the implantation of the rods, the patient presented a severe limitation of mobility that contraindicated the tendinous graft, so after confirming through doppler the permeability of both the posterior tibial artery and the functional reconstruction of the dorsalis pedis flap.
Anastomosis of the dorsal artery of the foot to the radial artery, of the saphenous vein to a superficial vein of the forearm, and the corresponding tendinous suture were performed.
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The donor site was immobilized for 10 days with a plaster splint, enough for the graft to predate.
The patient then began to walk freely with a simple bandage of the area and suffered no complications.
After 6 months postoperatively, the patient reported anesthesia exclusively in the donor area of the flap.
The hand was immobilized for 4 weeks and rehabilitation treatment was performed with active exercises protected for 8 weeks, obtaining a satisfactory functional result and reincorporation of the patient to work 3 months after the intervention.
