Hand: Tendon

Zone II Combined Flexor Digitorum Superficialis and Flexor Digitorum Profundus Repair Distal to the A2 Pulley

Pike JM, Gelberman RH (Washington Univ School of Medicine, St Louis, MO) J Hand Surg Am 35:1523-1527, 2010^§

Abstract

Combined transection of both the flexor digitorum superficialis (FDS) and the flexor digitorum profundus (FDP) tendons distal to the A2 pulley is challenging due to the intimacy of the FDS–FDP relationship at that level. This report describes our surgical technique for repair of combined FDS and FDP transections following decussation of the FDS tendon. Each slip of the FDS is repaired using 5-0 or 6-0 polypropylene sutures in a Becker configuration, creating a 4-strand repair for each slip. Repair of the FDP tendon is performed using Winters’ core-suture technique with looped 4-0 pseudomonofilament nylon suture, modified to achieve a locking loop and an 8-strand repair. The suture is placed with 1.2 cm of the lacerated end of the tendon, and a single knot is placed inside the repair site. We use a peripheral suture of 6-0 polypropylene for a running, nonlocked configuration to strengthen and tidy the repair. The suture is placed 2 mm from the lacerated edges of the apposed tendon ends and at least 2 mm deep into the substance of the tendon (rather than only within the epitenon). An early passive mobilization rehabilitation is preferred, with the aim to maximize intrasynovial excursion and minimize applied musculotendinous force.

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