New Developments Are Improving Flexor Tendon Repair

Summary: New developments in primary tendon repair over the past decades include stronger core tendon repair techniques, judicious and adequate venting of critical pulleys, followed by a combination of passive and active digital flexion and extension. During repair, core sutures over the tendon should have sufficient suture purchase (no shorter than 0.7 to 1 cm) in each tendon end and must be sufficiently tensioned to resist loosening, forming gaps. Slight or even modest bulkiness in the tendon substance at the repair site is not harmful, though marked bulkiness should always be avoided. To expose the tendon ends and reduce restriction to tendon gliding, the longest annular pulley in the fingers, i.e., the A2 pulley, can be vented partially with an incision over its distal or proximal sheath no longer than 1.5 to 2 cm; the annular pulley over the middle phalanx, i.e., the A4 pulley, can be vented entirely. Surgeons have not observed adverse effects on hand function after judicious and limited venting. The digital extension-flexion test to check the quality of the repair during surgery has become increasingly routine. A wide-awake surgical setting allows patient to actively move the digits. After surgery, surgeons and therapists protect patients in with a short splint, flexible wrist positioning, and are now moving towards out-of-splint freer early active motion. Improved outcomes have been reported over the last decade with minimal or no rupture during postoperative active motion and lower rates of tenolysis. Financial disclosure: None Corresponding author: Jin Bo Tang, MD, Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China; email: jinbotang@yahoo.com., Fax: 513-85110966, Phone: 86-513-85052524 ©2018American Society of Plastic Surgeons