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25th Anniversary Presentation| Volume 25, ISSUE 2, P214-235, March 2000

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Development of flexor tendon surgery: Twenty-five years of progress

      Regaining satisfactory digital function after flexor tendon laceration and repair within the digit has long been one of the most difficult problems in hand surgery. Until the 1960s it was universally recommended that tendons divided in the digit (then referred to as “no man's land”) should not be repaired. Bunnell taught that “it is better to remove the tendons entirely from the finger and graft in new tendons smooth throughout its length.”
      • Bunnell S.
      Repair of tendons in the fingers and description of two new instruments.
      That dictum remained sacrosanct until the 1960s when reports by Verdan,
      • Verdan CE.
      Primary repair of flexor tendons.
      • Verdan CE.
      Practical considerations for primary and secondary repair in flexor tendon injuries.
      Kleinert et al,
      • Kleinert HE
      • Kutz JE
      • Ashbell TS
      • Martinez E.
      Primary repair of lacerated flexor tendons in “no man's land.”.
      and Kessler and Nissim
      • Kessler I
      • Nissim F.
      Primary repair without immobilization of flexor tendon division within the digital sheath: an experimental and clinical study.
      challenged the concept that flexor tendons should not be repaired primarily. These investigators noted that when done correctly, immediate tendon suture would outperform secondary free tendon grafting. Armed by those encouraging reports, there was a gradual and cautious development of the concept and practice of primary flexor tendon repair. Initially, primary tendon repair was often combined with anecdotal protocols by Duran et al,
      • Duran RJ
      • Houser RG
      • Coleman CR
      • Stover MG.
      Management of flexor tendon lacerations in zone 2 using controlled passive motion postoperatively.
      Lister et al,
      • Lister GD
      • Kleinert HE
      • Kutz JE
      • Atasoy E.
      Primary flexor tendon repair followed by immediate controlled mobilization.
      and Strickland and Glogovac
      • Strickland JW
      • Glogovac SV.
      Digital function following flexor tendon repair in zone II: a comparison of immobilization and controlled passive motion techniques.
      for applying varying amounts of early post-repair motion to the repaired tendons.
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