Most of the major acute injuries of the hand will involved the tendons, either flexor or tendon lesions or both.

In programming the repair of tendons we have to evaluate all the others structures affected that need to be repair and remember that we should provide a good coverage of these structures.

In some situations it will be possible to suture the tendons directly, but in others we might need tendon grafts or to transfer some motor units for reconstruction of others, including the use of tendons of amputated parts. In other situations with grate tissue destruction and loss of pulleys of the flexor tendons it might be reasonable to do the reconstruction at a later procedure and to utilize silicone rods to maintain the space for a later reconstruction.

Tendon adhesions, joint stiffness, boutonniere and swan neck deformities are some of the complications that we might expect to have, even with a good rehabilitation program, and to solve at a later surgical procedure.