Surgical Technique|Articles in Press

Flexor Tendon Repair in Zone II Augmented With an Externalized Detensioning Suture: Protected Flexor Tendon Repair

Published:March 11, 2023DOI:
      Flexor tendon repair in zone II benefits from early finger motion to prevent stiffness. This article presents a technique that serves to augment a zone II flexor tendon repair with an externalized detensioning suture that can be used following any commonly employed repair method. This simple technique enables early active motion and is suited for patients who are less likely to be compliant after surgery or when the soft-tissue injury to the finger and hand is substantial. Although this technique substantially strengthens the repair, a possible drawback is that the tendon excursion distal to the repair is limited until the externalized suture is removed, which may lead to less motion of the distal interphalangeal than what may have occurred without the detensioning suture.

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        • Wolfe S.W.
        • Hotchkiss R.N.
        • Pederson W.C.
        • Kozin S.H.
        • Cohen M.S.
        • Seiler III, J.G.
        Flexor tendon injury.
        in: Green D.P. Operative Hand Surgery. Vol 1. 7th ed. Elsevier, 2017: 183-230
        • Starnes T.
        • Saunders R.J.
        • Means K.R.
        Clinical outcomes of zone II flexor tendon repair depending on mechanism of injury.
        J Hand Surg Am. 2012; 37: 2532-2540
        • Dinopoulos H.T.
        • Boyer M.I.
        • Burns M.E.
        • Gelberman R.H.
        • Silva M.J.
        The resistance of a four- and eight-strand suture technique to gap formation during tensile testing: an experimental study of repaired canine flexor tendons after 10 days of in vivo healing.
        J Hand Surg Am. 2000; 25: 489-498
        • McLarney E.
        • Hoffman H.
        • Wolfe S.W.
        Biomechanical analysis of the cruciate four-strand flexor tendon repair.
        J Hand Surg Am. 1999; 24: 295-301
        • Edsfeldt S.
        • Rempel D.
        • Kursa K.
        • Diao E.
        • Lattanza L.
        In vivo flexor tendon forces generated during different rehabilitation exercises.
        J Hand Surg Am. 2015; 40: 705-710
        • Hardwicke J.T.
        • Tan J.J.
        • Foster M.A.
        • Titley O.G.
        A systematic review of 2-strand versus multistrand core suture techniques and functional outcome after digital flexor tendon repair.
        Hand Surg Am. 2014; 39: 686-695
        • Başar H.
        • Tetik C.
        Modified Brunelli pull-out suture technique in zone II flexor tendon rupture: a fresh human cadaver study.
        Hand Surg. 2014; 19: 349-355
        • Georgescu A.V.
        • Matei I.R.
        • Capota I.M.
        • Ardelean F.
        • Olariu O.D.
        Modified Brunelli pull-out technique in flexor tendon repair for zone II: a study on 58 cases.
        Hand (N Y). 2011; 6: 276-281
        • Ökçesiz I.E.
        • Ege A.
        • Turhan E.
        • Songür M.
        • Bayar A.
        • Keser S.
        The longer pull-out suture as a transmission suture for early active motion of repaired flexor tendon at the proximal zone-2.
        Arch Orthop Trauma Surg. 2011; 131: 573-580
        • Abiri A.
        • Paydar O.
        • Tao A.
        • et al.
        Tensile strength and failure load of sutures for robotic surgery.
        Surg Endosc. 2017; 31: 3258-3270