Flexor tendon repair

Why are we operating?

Rejoining a cut flexor tendon inside its tight fibrous tunnel, then the paradox: a repair that must be strong enough to move on day one, because stillness is what ruins it.

Indication: Flexor tendon division in the hand or wrist; classically a knife or glass across the flexor surface.

The operation in 4 steps

1. 01Exploration

   The wound is extended along Bruner zigzag lines under tourniquet, and both tendon ends retrieved, the proximal end often having recoiled up the palm.

2. 02Assessing the zone

   The level of division is named by zone; zone II, where both flexor tendons share one sheath in the finger, changes the stakes.

3. 03The repair

   A multi-strand core suture joins the ends, tidied with a running epitendinous stitch.

4. 04Closure and early protected motion

   Skin closed, a dorsal blocking splint fitted, and a hand-therapy protocol of early protected movement started within days.

Anatomy you need

The forearm flexors and their tendons; in the finger both flexors share one sheath, which is why zone II is famous.

What can go wrong

• Surgical-site infection

  Wound erythema, warmth, discharge, and pain out of proportion, typically from postoperative day 4–7.