Challenges in restoration of extensor tendons function at the hand

Introduction: The authors discuss challenges in extensor function restoration at the finger level fol-lowing distal posterior interosseous or tendon complex injuries, according to the typologies of lesions or the specific patient requirements. Materials: The authors report on two cases describing challenging resolutions. One patient with EDC lag from zone 6B to 8 requiring FCU prolonged with cadaveric grafts. One young patient with distal posterior interosseous lesion requiring selective tendon transfers to EPL and EIP to restore selective and autonomous index extension. Results: In both cases the main goals were obtained, achieving high index of patient satisfaction and excellent outcomes with the restoration of the extension of the fingers. Conclusions: In distal posterior interosseous nerve lesion, high demanding patients may require selective func-tion to restore fine motor skills, such as autonomous index extension. In extensor tendons loss of substance from zone 6 to 8, involving musculotendinous junction proximally and short remnants distally, by-pass ten-don transfer prolonged with cadaveric grafts is required. The authors highlight the techniques available as escape plan according to the necessary solutions.