Tendon injuries are among the most common — and most consequential — injuries in the hand. The hand contains an intricate system of flexor tendons (which bend the fingers and thumb) and extensor tendons (which straighten them), each anchored to specific muscles in the forearm and traveling through specific anatomical compartments. A torn or severed tendon means the loss of a specific motion the patient previously took for granted: bending a finger, gripping an object, extending the wrist. The treatment of a torn tendon is surgical, and the timing matters more than most patients realize — once severed, tendons begin to shrink, and the optimal repair window is narrow. Tendon repairs include both flexor tendon repair and extensor tendon repair, and each requires specific surgical technique to restore both anatomical continuity and functional motion. At Los Angeles Plastic Surgery in Beverly Hills, Dr. John Anastasatos performs flexor and extensor tendon repair with the depth of training this delicate microsurgical work specifically requires.

Dr. Anastasatos performs tendon repair with the most directly relevant academic credential possible: he completed a fellowship in Hand and Upper Extremity Surgery and Microsurgery at the University of Alabama at Birmingham — formal subspecialty training in the microsurgical techniques tendon repair specifically requires. He has presented academic work at UAB Grand Rounds on “The Microsurgical Repair of Peripheral Nerves” — work directly relevant to the precision microsurgery used in tendon and adjacent nerve repair, since hand tendon injuries frequently involve concurrent nerve damage. Dr. Anastasatos trained in plastic surgery under Dr. Luis Vasconez at UAB, one of history’s foremost plastic surgeons. With over two decades of facial and hand surgical expertise in Beverly Hills since 2007, he is board certified by the American Board of Plastic Surgery, a Fellow of the American College of Surgeons (FACS), a member of the American Society of Plastic Surgeons (ASPS) and American Society for Aesthetic Plastic Surgery (ASAPS), and named by The Luxe Insider as one of the Top 10 Plastic Surgeons in the World.

Initial Management of Tendon Injuries

Tendon injuries are usually associated with open wounds, cuts, or lacerations — and ideal management begins at the time of injury. The patient should be taken to the operating room, where the wounds are washed out, irrigated with antibiotic solution, and debrided of all foreign bodies and desiccated or non-viable tissue. With the wound prepared, the tendons are addressed.

Tendon lacerations may be partial or complete. In either case, repair is by suture re-approximation — a precise microsurgical technique that aligns the tendon ends and restores continuity.

When ER Care Cannot Repair the Tendon Immediately

In real-world practice, patients often present to an emergency room after a laceration that has — among other injuries — severed a tendon. A specialized hand surgeon may not be available during the ER visit. In that situation, the appropriate sequence is:

• ER bedside care: the ER physician washes out the wound, performs bedside debridement, closes the wound, and starts the patient on antibiotics
• Hand surgeon referral: the patient is then referred to a hand surgeon for proper operative tendon repair

This sequence prevents wound infection while preserving the option of definitive tendon repair within the optimal time window.

The 2-3 Week Repair Window

Tendon repair should ideally occur within 2-3 weeks of the time of injury. The reason is biological: once severed, tendons begin to shrink, and after 3 weeks it may not be possible to approximate the cut ends effectively. Patients who delay beyond this window often require more complex reconstruction.

The traction applied to the tendon repair matters as well. The severed tendon edges must be repaired under the same tension they would experience under normal uninjured conditions. Repair under inappropriate tension — too tight or too loose — produces poor functional results.

When Repair Is Delayed: Tendon Grafting

For cases where tendon repair does not occur within a few weeks of the initial injury and hand function is impaired, tendon repair and reconstruction can still be achieved using interposition tendon grafts — donor tendon segments that bridge the gap between the shrunken tendon ends. This more complex reconstruction restores function but with a longer recovery and somewhat different functional ceiling than primary repair.

Postoperative Therapy and Adhesion Prevention

Therapy following tendon repair is essential to a good functional outcome — and begins early:

• Early passive motion exercises — promote healing while preventing adhesions at the tendon repair site
• Adhesion prevention — adhesions form as a normal consequence of surgery and can prevent the proper excursion of tendon motion, even when the surgical repair itself is technically perfect
• Botox to associated muscles — Botox can be used to weaken (not inactivate) the muscles associated with the repaired tendons. A weaker muscle exerts less traction on the tendon repair site, which can promote tendon healing during the early postoperative period.

The combination of precise microsurgical repair and early protected motion is what produces the best functional outcomes after tendon injury.

Schedule a Tendon Repair Consultation in Beverly Hills

For acute tendon injuries or evaluation of a previously injured hand with persistent functional limitation, Dr. Anastasatos welcomes patients to the Beverly Hills office at 436 North Bedford Drive, Suite 202, Beverly Hills, CA 90210, for evaluation and treatment. Contact Los Angeles Plastic Surgery to schedule a consultation with Dr. Anastasatos.