Primary Repair of Flexor Tendons

TLDR

The prevailing view that tendon grafts should be preferred over primary repair in Bunnell's no man's land is overly stringent, and delayed grafting is justified only for inexperienced surgeons or when immediate repair is contraindicated. For clean, fresh flexor‑tendon lacerations, specialists perform primary sutures by excising the sublimis, accurately stitching the profundus with fine epitendinous stitches, resecting the sheath, and immobilizing the ends with two transverse stainless‑steel pins to eliminate tension, a method that is especially warranted for multiple simultaneous lacerations. If adhesions impede gliding, secondary tenolysis yields functional results often superior to those achieved by tendon grafts.

Abstract

The rule hitherto adopted that tendon grafts should be performed in preference to primary repair of tendons cut in Bunnell's no man's land is too rigorous. Delayed tendon-grafting is only justified for those physicians having no experience in hand surgery or when general or local conditions do not allow immediate repair. For cleanly cut, fresh wounds, specialists capable of performing tendon grafts correctly, are a fortiori qualified to effect successful primary sutures. The technique proposed consists in excising the sublimis, suturing the profundus accurately with fine epitendinous stitches, resecting the sheath in the region of the repair, and immobilizing the ends of the tendon with two transverse stainlesssteel pins to prevent tension on the delicate suture line, which is comparable to that in a nerve suture. Should adhesions hinder gliding, a secondary tenolysis will produce functional results often better than those obtained by tendon grafts. For multiple simultaneous flexor-tendon lacerations in several digits, primary repair is even more justified than for a tendon laceration in one digit.