Acute flexor tendon surgery

OBJECTIVE: Flexor tendon repair by direct suture, providing tendon function and mechanical properties and allowing postoperative active extension and flexion. INDICATIONS: Flexor tendon laceration in all zones, when primary healing and a good functional outcome can be expected. CONTRAINDICATIONS: Florid and chronic infection. Lack of skill, instruments, or manpower. Tension-free suture is not feasible. Severe soft-tissue problems. Mantero suture in case of coexistent artery injury. SURGICAL TECHNIQUE: Hand surgical incisions and approach to the tendon. Opening of the tendon sheath in the region of oblique pulley. A four-strand core suture consisting of two locked two-strand sutures and a circumferential epitendon cross-stitch suture are performed. Lacerations in zone I with a tendon stump shorter than 1 cm require a Mantero suture and avulsions require a pull-out suture technique. POSTOPERATIVE MANAGEMENT: Active flexion and active extension in a dorsal wrist cast. RESULTS: The clinical outcome studies after repair of zone II flexor tendon injuries using a multiple-strand suture technique describe 69-96% excellent and good results.