Repair Of Flexor Tendon In Zone II Using Minimal Incisions

Flexor tendon laceration in the hand is a common injury with unique characteristics owing to the anatomy of flexor tendons contained within a flexor sheath, requiring good surgical technique as well as strict rehabilitation protocol for regaining function.

The hand is divided into 5 zones (Verdan's). Zone II is described by Bunnel as "No Man's Land" historically back to the 14th century (an area outside London used for executions) because it was previously believed that primary repair should not be done in this zone. After understanding flexor tendon anatomy, biomechanics, and healing new techniques of surgery and anesthesia repair is possible with good results.

Lacerated tendons in zone II can retract proximally to the PIP if the vinculum longus is intact or into the palm if it is disrupted. It will not retract to the level of the wrist because of the origin of the lumbrical insertion into the extensor mechanism.

The laceration can be extended in a Brunner incision or a mid-lateral exposure but it is better skin incisions are minimal to minimize postoperative finger edema, potential adhesions, and injury of any delicate structures.

There are a lot of techniques to retrieve the proximal tendon end as milking, using a hemostat or second incision proximal to the A1 pulley where the tendon is tied to a looped wire of silastic tube and pulled distally through the laceration in the tendon sheath. But little studies discuss the effect of minimal incision on functional outcomes post-operative.

Inclusion criteria

Age: between 16-60 years.

• Flexor tendon injuries of zone II of any medial four digits in both genders.
• within two weeks.
• Sharp mechanism of injury.
• Single-level injury
• Minimal surgical incision.

Exclusion criteria

• Age less than sixteen years old or more than sixty years old.
• Amputation requiring replantation.
• Vascular injury requiring revascularization
• Associated fractures close to the tendon injury.
• Combined flexor and extensor tendon injury.
• Multiple-level injury
• Tendon substance loss
• Insufficient skin and soft tissue coverage.
• Surgical incision for whole tendon exposure.