Journal of Hand Surgery
Volume 35, Issue 5 , Pages 785-790 , May 2010

Primary Pulley Enlargement in Zone 2 by Incision and Repair With an Extensor Retinaculum Graft

  • Robert E. Bunata, MD

      Affiliations

    • Corresponding Author InformationCorresponding author: Robert E. Bunata, MD, University of North Texas Health Science Center, 3500 Camp Bowie Blvd. EAD-432, Fort Worth, TX 76104

Received 19 November 2008 ,Accepted 29 January 2010.

References 

  1. Lister G. Incision and closure of the flexor sheath during primary tendon repair. Hand. 1983;15:123–135
  2. Lister GD. Indications and techniques for repair of the flexor tendon sheath. Hand Clin. 1985;1:85–95
  3. Manske P. Flexor tendon healing. J Hand Surg. 1988;13B:237–245
  4. Strickland JW. Flexor tendon injuries: part 2 (Flexor tendon repair). Orthop Rev. 1986;15:701–721
  5. Elliot D. Primary flexor tendon repair: operative repair, pulley management and rehabilitation. J Hand Surg. 2002;27B:507–513
  6. Kwai Ben I, Elliot D. “Venting” or partial lateral release of the A2 and A4 pulleys after repair of zone 2 flexor tendon injuries. J Hand Surg. 1998;23B:649–654
  7. Tang JB. Indications, methods, postoperative motion and outcome evaluation of primary flexor tendon repairs in Zone 2. J Hand Surg. 2007;32B:118–129
  8. Tang JB. Clinical outcomes associated with flexor tendon repair. Hand Clin. 2005;21:199–210
  9. Boyer MI, Strickland JW, Engles D, Sachar K, Leversedge FJ. Flexor tendon repair and rehabilitation: state of the art in 2002. Instr Course Lect. 2003;52:137–161
  10. Strickland JW. Development of flexor tendon surgery: twenty-five years of progress. J Hand Surg. 2000;25A:214–235
  11. Verdan CE. Primary repair of flexor tendons. J Bone Joint Surg. 1960;42A:647–657
  12. Osada D, Fujita S, Tamai K, Yamaguchi T, Iwamoto A, Saotome K. Flexor tendon repair in zone II with 6-strand techniques and early active mobilization. J Hand Surg. 2006;31A:987–992
  13. Kleinert HE, Kutz JE, Atasoy E, Stormo A. Primary repair of flexor tendons. Orthop Clin North Am. 1973;4:865–876
  14. Symposium on tendon surgery in the handKleinert HE, Kutz JE, Cohen MJ. Primary repair of zone 2 flexor tendon lacerations. In: American Academy of Orthopaedic Surgery, ed. Saint Louis: CV Mosby; 1975;p. 91–104
  15. Elliot D, Moiemen NS, Flemming AF, Harris SB, Foster AJ. The rupture rate of acute flexor tendon repairs mobilized by the controlled active motion regimen. J Hand Surg. 1994;19B:607–612
  16. Silfverskiold KL, May EJ. Flexor tendon repair in zone II with a new suture technique and an early mobilization program combining passive and active flexion. J Hand Surg. 1994;19A:53–60
  17. Lister GD, Kleinert HE, Kutz JE, Atasoy E. Primary flexor tendon repair followed by immediate controlled mobilization. J Hand Surg. 1977;2:441–451
  18. Small JO, Brennen MD, Colville J. Early active mobilisation following flexor tendon repair in zone 2. J Hand Surg. 1989;14B:383–391
  19. Tang JB, Zhang QG, Ishii S. Autogenous free sheath grafts in reconstruction of injured digital flexor tendon sheath at the delayed primary stage. J Hand Surg. 1993;18B:31–32
  20. Baktir A, Turk CY, Kabak S, Sahin V, Kardas Y. Flexor tendon repair in zone 2 followed by early active mobilization. J Hand Surg. 1996;21B:624–628
  21. Kessler I, Nissim F. Primary repair without immobilization of flexor tendon division within the digital sheath: an experimental and clinical study. Acta Orthop Scand. 1969;40:587–601
  22. Strickland JW, Glogovac SV. Digital function following flexor tendon repair in zone II: a comparison of immobilization and controlled passive motion techniques. J Hand Surg. 1980;5A:537–543
  23. Allen BN, Frykman GK, Unsell RS, Wood VE. Ruptured flexor tendon tenorrhaphies in zone II: repair and rehabilitation. J Hand Surg. 1987;12A:18–21
  24. Dowd MB, Figus A, Harris SB, Southgate CM, Foster AJ, Elliot D. The results of immediate re-repair of zone 1 and 2 primary flexor tendon repairs which rupture. J Hand Surg. 2006;31B:507–513
  25. Harris SB, Harris D, Foster AJ, Elliot D. The aetiology of acute rupture of flexor tendon repairs in zones 1 and 2 of the fingers during early mobilization. J Hand Surg. 1999;24B:275–280
  26. Tanaka T, Amadio PC, Zhao C, Zobitz ME, Yang C, An KN. Gliding characteristics and gap formation for locking and grasping tendon repairs: a biomechanical study in a human cadaver model. J Hand Surg. 2004;29A:6–14
  27. Messina A, Messina JC. The direct midlateral approach with lateral enlargement of the pulley system for repair of flexor tendons in fingers. J Hand Surg. 1996;21B:463–468
  28. Paillard PJ, Amadio PC, Zhao C, Zobitz ME, An KN. Pulley plasty versus resection of one slip of the flexor digitorum superficialis after repair of both flexor tendons in zone II: a biomechanical study. J Bone Joint Surg. 2002;84A:2039–2045
  29. Zhao C, Amadio PC, Zobitz ME, An KN. Resection of the flexor digitorum superficialis reduces gliding resistance after zone II flexor digitorum profundus repair in vitro. J Hand Surg. 2002;27A:316–321
  30. Tang JB, Xie RG, Cao Y, Ke ZS, Xu Y. A2 pulley incision or one slip of the superficialis improves flexor tendon repairs. Clin Orthop Relat Res. 2007;456:121–127
  31. Dona E, Walsh WR. Flexor tendon pulley V-Y plasty: an alternative to pulley venting or resection. J Hand Surg. 2006;31B:133–137
  32. Bunata RE, Kosmopoulos V, Simmons S, Tayag TJ, Roso M, Carlson H. Primary tendon sheath enlargement and reconstruction in zone 2: an in vitro biomechanical study on tendon gliding resistance. J Hand Surg. 2009;34A:1436–1443
  33. Tang JB, Wang YH, Gu YT, Chen F. Effect of pulley integrity on excursions and work of flexion in healing flexor tendons. J Hand Surg. 2001;26A:347–353
  34. Amadio PC. Friction of the gliding surface: implications for tendon surgery and rehabilitation. J Hand Ther. 2005;18:112–119
  35. Strickland JW. The scientific basis for advances in flexor tendon surgery. J Hand Ther. 2005;18:94–110
  36. Zhao C, Amadio PC, Paillard P, Tanaka T, Zobitz ME, Larson DR, et al. Digital resistance and tendon strength during the first week after flexor digitorum profundus tendon repair in a canine model in vivo. J Bone Joint Surg. 2004;86A:320–327
  37. Cullen KW, Tolhurst P, Lang D, Page RE. Flexor tendon repair in zone 2 followed by controlled active mobilisation. J Hand Surg. 1989;14B:392–395
  38. Bowers WH, Kuzma GR, Bynum DK. Closed traumatic rupture of finger flexor pulleys. J Hand Surg. 1994;19A:782–787
  39. Kessler FB, Epstein MJ, Lannik D, Maher D, Pappu S. Fascia patch graft for a digital flexor sheath defect over primary tendon repair in the chicken. J Hand Surg. 1986;11A:241–245
  40. Tang JB, Shi D, Zhang QG. Biomechanical and histologic evaluation of tendon sheath management. J Hand Surg. 1996;21A:900–908
  41. Young RE, Harmon JM. Repair of tendon injuries of the hand. Ann Surg. 1960;151:562–566
  42. Kitsis CK, Wade PJ, Krikler SJ, Parsons NK, Nicholls LK. Controlled active motion following primary flexor tendon repair: a prospective study over 9 years. J Hand Surg. 1998;23B:344–349

 No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.

PII: S0363-5023(10)00124-3

doi: 10.1016/j.jhsa.2010.01.032

Journal of Hand Surgery
Volume 35, Issue 5 , Pages 785-790 , May 2010