In short. Plastic surgical repair of hand injuries and tendon loss: primary tendon repair, grafts and transfers, nerve repair, and why rehabilitation determines the result as much as surgery.
Key points
- Primary repair rejoins tendon ends directly and gives the best result when the injury is fresh and clean.
- When tendon substance is lost or the injury is old, a graft — spare tendon borrowed from the forearm or foot — bridges the gap, sometimes in two stages with a temporary spacer to preserve the tunnel.
- Tendon transfers take over a lost function using an expendable working tendon and are the mainstay when the original muscle is permanently paralyzed.
The hand concentrates more function per square centimetre than any other part of the body, and its injuries punish delay and reward precision. Plastic surgical hand reconstruction covers cut flexor and extensor tendons, damaged nerves, lost skin cover, and the late consequences — stiffness, contracture, and loss of pinch and grip — that follow when early treatment was missed or failed.
The problem being solved
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 — 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.
Who it suits — and the timing rule
Acute tendon and nerve injuries are best repaired within days, once the wound is clean; contaminated or crushed wounds may be staged. Late reconstruction — tendon grafts, tendon transfers that re-route a working tendon to do a lost job, 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.
The options compared
Repair, graft, or transfer
Primary repair rejoins tendon ends directly and gives the best result when the injury is fresh and clean. When tendon substance is lost or the injury is old, a graft — spare tendon borrowed from the forearm or foot — bridges the gap, sometimes in two stages with a temporary spacer to preserve the tunnel. Tendon transfers take over a lost function using an expendable working tendon and are the mainstay when the original muscle is permanently paralyzed. Nerve gaps are bridged with grafts; skin deficits over gliding structures are covered with flaps. The choice follows what is missing, not habit.
Operative details and rehabilitation
Repairs use magnification, fine core sutures strong enough to allow early protected motion, and regional or general anaesthesia. The postoperative splinting and hand-therapy programme — controlled early movement to prevent adhesions without rupturing the repair — is prescribed with the same care as the operation itself and 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.
Seek hand surgical care promptly if
- A cut on the hand or forearm leaves a finger that will not bend or straighten actively, or a numb area beyond the wound.
- A repaired tendon repair suddenly gives way or a finger that moved stops moving — suspected rupture is time-critical.
- A hand injury is more than a few days old and untreated — options narrow with each week of delay.
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.