- advantages include similar amplitude and direction of pull;                  - prerequisites include independent extension of the index finger;                  - graft should be harvested just proximal to the extensor hood, w/ care taken to anatomically repair the saggital hood (see extensor mechanism);                          - one incision is made at the mp joint level inorder to harvest the tendon;                          - second incision is made just distal to the extensor retinaculum (which allows the tendon to be delivered and then rerouted);                  - incision is made over the thumb mp joint, and a subq tunnel is created to the retinacular incision;                  - the tendon is then delivered thru this tunnel;                  - the most difficult part of the case is proper tensioning;                          - inorder to achieve full extension, often the graft will have to be tensioned to the point that some ip joint flexion will be lost;                          - many surgeons advocate slight to moderate overtensioning of this graft inorder to overcome the much stronger fpl;                                 - worst case scenario w/ this approach is slight loss of full flexion;                          - immobilization in full extension is emphasized;                  - main disadvantage of this transfer is that it precludes its use for other tendon transfers (should this be necessary in the future);           - apl to epl transfer:                  - this may be a good choice in rheumatoid arthritis;                  - even though the apl has decreased amplitude (3 cm vs 6 cm for the epl), it has the same                         direction of pull, and affords the patient good function;      - joint arthrodesis:           - arthrodesis improves strength & maintains f(x), where as efforts at reconstruction of joint,                 if articular surface is severely damaged, will be unsuccessful rupture of the extensor pollicis longus tendon. Cheap viagra next day delivery Viagra for sale usa gold max viagra     chmell s, et al. female viagra pictures female viagra que es viagra without prescriptions uk viagra canada internet  orthopaedics. http://medicaresupplementspecialists.com/pfz-buy-online-viagra-pa/ viagra generic discount viagra cheap online discounted viagra 1983;6:565. female viagra que es generic viagra for sale online generic viagra fast shipping buy viagra in us    spontaneous rupture of the exte. http://howtosmudge.com/pjn-cheapest-viagra-online-pharmacy-hc/ online sale viagra purchase viagra online without prescription generic viagra soft tabs 50 mg viagra pills sale canada female viagra que es


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