A tendon graft replaces a length of tendon that has been lost or scarred beyond repair, using a spare tendon taken from elsewhere in the body. It restores the mechanical link between muscle and bone so movement can return.
A tendon graft is a strip of tendon borrowed from a site where it can be spared and stitched in to replace a damaged tendon. Surgeons use it when the cut ends have retracted, scarred or been lost, so direct repair is not possible. After surgery, a period of splinting and guided hand therapy decides how much movement is regained.
Tendons are the tough cords that transmit the pull of a muscle to a bone. When a tendon is cut and treated early, the two ends can usually be stitched together. Left alone, however, the muscle pulls the upper end away and the tendon retracts, scars and shortens. By the time some patients reach a surgeon, direct repair is no longer possible and a graft has to fill the space.
The donor choice depends on the length required. For a short graft in the hand, the palmaris longus tendon at the front of the wrist is often used, and a simple test at consultation shows whether you have one, since some people do not. For longer reconstructions, the plantaris tendon in the calf or a tendon from the second toe may be taken instead. In each case the donor tendon has neighbours that perform the same job, so its removal is well tolerated.
The graft is threaded through the tendon sheath and secured at both ends, with the tension set carefully against the natural resting posture of the hand. Too loose and the finger will not bend fully, too tight and it will not straighten. Surgery is sometimes staged, with a silicone rod placed first to create a smooth tunnel before the graft goes in.
Tendon grafting works when the joints still move passively and the tissue bed is healthy. Without those two things, even excellent surgery will not deliver movement.
Before anything else, the surgeon checks that the joints move passively and that the overlying skin is healthy. Stiff joints are treated with therapy first, because a graft cannot move a joint that is already fixed.
A spare tendon is taken through small incisions, most often the palmaris longus at the wrist, or the plantaris or a toe extensor when greater length is needed.
Scar tissue is cleared from the old tendon path so the graft can glide. In difficult cases a silicone rod is placed at a first operation to form a smooth sheath before grafting.
Both ends of the graft are woven and stitched to the remaining tendon or to bone. Tension is set against the natural cascade of the fingers so the digit both bends and straightens.
A protective splint holds the hand in a safe position. Hand therapy begins under supervision, with controlled movement introduced in stages to encourage gliding without breaking the repair.
The hand is splinted and elevated to limit swelling. Discomfort is managed with prescribed medication, and you are shown exactly which movements are allowed and which are not.
Dressings are reduced and a therapy splint is fitted. Guided gentle movement usually begins in this period, since early controlled gliding helps prevent the graft sticking down in scar.
The splint is often discarded and active exercises progress. Strength is still limited, and lifting or gripping firmly is avoided until the therapist confirms the graft has matured.
Grip strength and endurance continue to build. Scars soften, stiffness eases, and the therapist gradually returns you to work tasks, sport or instrument playing as appropriate.
A successful graft usually restores useful movement rather than the exact range of an uninjured finger. Some stiffness and a slight loss of full bend or full extension are common, and scar around the graft can limit gliding. Results depend heavily on joint suppleness beforehand and on commitment to therapy afterwards. A second procedure to release adhesions is occasionally needed. Most patients gain function that makes daily tasks noticeably easier.
Both the hand and the donor site carry risks, and outcomes in tendon surgery vary more than in many other operations. Your surgeon will be frank about this.
The hand needs protection and controlled movement, while the forearm or calf donor wound simply needs to heal quietly. Both are reviewed at follow up.
Movement depends on therapy. A graft that is not moved in a controlled way sticks down in scar and delivers far less than it could.
The donor tendons chosen have neighbours doing the same job. Some people are born without a palmaris longus and never notice its absence.
Grafting exists precisely for late cases. What matters more than time alone is whether the joints still move passively and the skin is healthy.
Useful movement is the realistic aim. Some loss of full bend or full straightening is common, and therapy determines how close to normal the finger becomes.
Hand reconstruction at Elegance Clinic in Surat is planned together with hand therapy, because the result depends on both. Dr. Ashutosh Shah assesses joint movement and skin quality carefully before recommending a graft.
Technique pages do not carry their own price, because the cost depends on the treatment the technique is used within. A tendon graft performed during hand trauma reconstruction, tendon transfer or revision surgery is priced as part of that operation. Please check the relevant treatment page for its band, and ask for a written estimate at consultation.
These are the questions that come up most often in consultation. If yours is not here, send it on WhatsApp and the team will reply, usually the same day.
Ask your question →The graft is not priced separately. It is one component of a larger hand operation, so the cost belongs to that treatment. Review the treatment page relevant to your injury, and ask for a written estimate that also covers hand therapy sessions.
Commonly from the palmaris longus at the front of the wrist for short grafts. When more length is required, the plantaris tendon in the calf or a tendon from the second toe is used. A simple clinic test shows which is available.
The donor tendons chosen have other tendons performing the same action, so strength is preserved. Some people are naturally born without a palmaris longus and never notice. A small scar and occasional tenderness are the usual trade.
Splinting usually lasts several weeks, with the position and the amount of allowed movement changing as healing progresses. Your therapist adjusts this at each visit. Removing the splint early risks stretching or pulling apart the repair.
Yes. Controlled early movement stops the graft sticking down in scar, and later exercises build gliding and strength. Surgery provides the tendon, while therapy determines how well it moves. Skipping sessions is the most common reason results disappoint.
Light desk work often resumes within a few weeks with the splint in place. Manual work involving gripping, lifting or tools usually waits several months. Your therapist will test grip and endurance before clearing you.
Often yes. What matters is whether the joints still move passively, the skin is healthy and the muscle still works. If joints have stiffened, therapy or a preliminary procedure may be needed before grafting is considered.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
