In short. Hand and tendon reconstruction repairs cut flexor and extensor tendons, damaged nerves and lost skin cover, and addresses the stiffness and contracture that follow delayed treatment. Primary repair gives the best result in a fresh clean wound; where tendon is lost or the injury is old, grafts and transfers are used.
Key points
- Adhesions are the central enemy of tendon surgery, because the healing zone glues to surrounding tissue.
- Primary repair rejoins tendon ends directly and works best in fresh clean wounds.
- Grafts bridge a gap when tendon substance is lost; transfers take over a paralysed function.
- Nerves regenerate at about a millimetre a day while muscle and sensation degrade.
- Surgery without hand therapy produces stiff hands.
What makes the hand different
The hand concentrates more function per square centimetre than any other part of the body, and its injuries punish delay and reward precision. Hand reconstruction covers cut flexor and extensor tendons, damaged nerves, lost skin cover, and the late consequences of missed or failed early treatment, which are stiffness, contracture, and loss of pinch and grip.
Why adhesions are the central problem
Flexor tendons run in tight fibrous tunnels; a clean cut leaves ends that retract and, after repair, a healing zone that wants to glue itself to everything around it. Adhesions are the central enemy of tendon surgery. Nerves, once cut, regenerate slowly, at about a millimetre a day, and the muscles and sensory organs they serve degrade while waiting. Skin loss over tendons or joints needs durable, gliding cover, often a flap rather than a graft.
When should a tendon injury be repaired?
Acute tendon and nerve injuries are best repaired within days, once the wound is clean; contaminated or crushed wounds may be staged. Late reconstruction, which covers tendon grafts, transfers, joint releases and scar correction, suits patients whose function remains limited after healing. The absolute requirement at every stage is commitment to rehabilitation: surgery without therapy produces stiff hands.
Repair, graft or transfer
| Option | What it does | When it is used | What limits it |
|---|---|---|---|
| Primary repair | Rejoins tendon ends directly | A fresh, clean injury | It needs the ends to be repairable and the wound clean |
| Tendon graft | Bridges a gap with spare tendon from the forearm or foot | Tendon substance is lost or the injury is old | Sometimes two stages with a temporary spacer |
| Tendon transfer | Re-routes an expendable working tendon to take over a lost function | The original muscle is permanently paralysed | It is planned around what remains |
| Nerve graft | Bridges a nerve gap | A nerve has been cut | Regeneration is slow, about a millimetre a day |
| Flap | Covers skin deficits over gliding structures | Skin loss over tendons or joints | The cover must be durable and glide |
Repairs use magnification, fine core sutures strong enough to allow early protected motion, and regional or general anaesthesia. The choice follows what is missing, not habit.
What does the operation and aftercare involve?
The postoperative splinting and hand-therapy programme is prescribed with the same care as the operation itself. Controlled early movement prevents adhesions without rupturing the repair, and the programme continues for three months or more.
What surgery can and cannot achieve
It can restore useful flexion and grip in most fresh, clean injuries, and worthwhile function in many late ones. It cannot reliably restore a fully normal range of motion after severe or delayed injury, and sensation after nerve repair in adults is always imperfect. Stiffness, not strength, is usually what separates a good result from a poor one.
Complications and secondary surgery
Risks include repair rupture, infection, adhesions requiring a second release operation (tenolysis), joint stiffness, and complex regional pain. A meaningful proportion of tendon repairs benefit from planned secondary procedures, and honest consent includes that possibility from the start.
Sources
- British Society for Surgery of the Hand: patient information on tendon injuries
- American Society for Surgery of the Hand: patient information on flexor tendon repair
- Cochrane Library: systematic reviews on rehabilitation after flexor tendon repair
Source links open each organisation's search results for the topic. Document-level confirmation is pending the reviewer's sign-off.
Internal links
Frequently asked questions
Why are tendon injuries repaired so urgently?
Tendon ends retract after a cut and the healing zone wants to glue itself to everything around it, so adhesions are the central enemy. A fresh, clean wound repaired within days gives the best chance of gliding movement; contaminated or crushed wounds may need staging.
When is a tendon transfer used rather than nerve repair?
It re-routes an expendable working tendon to take over a function whose original muscle is permanently paralysed. It is the mainstay of late reconstruction, used when the tendon itself is lost or the muscle can no longer pull, and it is planned around what remains.
Why is hand therapy as important as the operation?
Surgery without therapy produces stiff hands. Controlled early movement under a splint programme prevents adhesions without rupturing the repair, and it continues for three months or more. Stiffness, rather than strength, is usually what separates a good result from a poor one.
Risks & Limitations
- Reconstruction is usually staged — more than one operation is normal, and the plan may change as healing progresses.
- Donor-site scarring and discomfort, including after rib cartilage harvest.
- Partial or complete failure of a flap or graft, which may require further surgery.
- Scars are permanent. They mature and fade but never disappear.
- Asymmetry and the inherent limits of matching a normal side.
- Altered sensation, numbness or weakness in the operated area.
- Contracture, which may need release procedures later.
- Final assessment is made at 6–12 months, and longer in growing children.
When to Seek Care
- A flap or graft that turns dark, cold, black or stops bleeding when pricked.
- Fever above 38 °C, or spreading redness, warmth or discharge around a wound.
- New or worsening pain, swelling or fluid leakage from the operative site.
- Bleeding that does not stop with gentle pressure.
- Any change in a reconstructed area that concerns you, however minor.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — reconstructive surgery guidance
- World Health Organization (WHO) — burn and trauma care resources
- Chinese Medical Association, Plastic Surgery Branch — clinical guidance
- Cochrane Library — systematic reviews in wound and reconstructive care
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.