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Review
. 2010 Sep;35(9):1523-7.
doi: 10.1016/j.jhsa.2010.06.024.

Zone II combined flexor digitorum superficialis and flexor digitorum profundus repair distal to the A2 pulley

Jeffrey M Pike  1 , Richard H Gelberman
Affiliations
Review

Zone II combined flexor digitorum superficialis and flexor digitorum profundus repair distal to the A2 pulley

Jeffrey M Pike et al. J Hand Surg Am. 2010 Sep.
No abstract available

PubMed Disclaimer

Figures

Figure 1
Figure 1. Flexor tendon anatomy exposed between the A2 and A4 pulleys
A: Oblique view without laceration; note the vinculum longus profundus emerging just distal to the FDS decussation (arrow) and the radial and ulnar bundles of the FDP tendon clearly marked by the longitudinal groove between them (arrowhead). B: Volar perspective after laceration. C: Axial perspective demonstrating the ovoid shape of the FDP tendon, and the flat shape to the FDS slips.
Figure 1
Figure 1. Flexor tendon anatomy exposed between the A2 and A4 pulleys
A: Oblique view without laceration; note the vinculum longus profundus emerging just distal to the FDS decussation (arrow) and the radial and ulnar bundles of the FDP tendon clearly marked by the longitudinal groove between them (arrowhead). B: Volar perspective after laceration. C: Axial perspective demonstrating the ovoid shape of the FDP tendon, and the flat shape to the FDS slips.
Figure 1
Figure 1. Flexor tendon anatomy exposed between the A2 and A4 pulleys
A: Oblique view without laceration; note the vinculum longus profundus emerging just distal to the FDS decussation (arrow) and the radial and ulnar bundles of the FDP tendon clearly marked by the longitudinal groove between them (arrowhead). B: Volar perspective after laceration. C: Axial perspective demonstrating the ovoid shape of the FDP tendon, and the flat shape to the FDS slips.
Figure 2
Figure 2. FDS repair
Becker suture of the ulnar one-half of an FDS slip using 5-0 Prolene. This is repeated for each half of FDS slips on both sides of the laceration. This allows for a four-strand repair of each slip.
Figure 3
Figure 3. FDP repair
A: Diagram depicting final repair and suture configuration. B: 4-0 looped Supramid suture. C: The initial pass is placed with a purchase length of 1.2 cm (arrowhead ‘1’); placement of transverse pass closer to lacerated tendon end to create a locking loop (arrowhead ‘2’). D: The third pass enters further from the lacerated end than the transverse pass to create a second locking loop (arrowhead ‘3’). The same passes are performed on the opposite tendon end to complete the first sequence of passes (4 strands now cross the repair site). E: Note that the suture limbs are exiting the radial and ulnar bundles of the tendon from their radial aspects (arrows); the second sequence of passes will utilize the ulnar half of the bundles to complete the 8-strand repair. F: Once the first sequence of passes is completed for the other tendon end, the ends are gently approximated to avoid ‘locking’ the ends apart prior to knot-tying.
Figure 3
Figure 3. FDP repair
A: Diagram depicting final repair and suture configuration. B: 4-0 looped Supramid suture. C: The initial pass is placed with a purchase length of 1.2 cm (arrowhead ‘1’); placement of transverse pass closer to lacerated tendon end to create a locking loop (arrowhead ‘2’). D: The third pass enters further from the lacerated end than the transverse pass to create a second locking loop (arrowhead ‘3’). The same passes are performed on the opposite tendon end to complete the first sequence of passes (4 strands now cross the repair site). E: Note that the suture limbs are exiting the radial and ulnar bundles of the tendon from their radial aspects (arrows); the second sequence of passes will utilize the ulnar half of the bundles to complete the 8-strand repair. F: Once the first sequence of passes is completed for the other tendon end, the ends are gently approximated to avoid ‘locking’ the ends apart prior to knot-tying.
Figure 3
Figure 3. FDP repair
A: Diagram depicting final repair and suture configuration. B: 4-0 looped Supramid suture. C: The initial pass is placed with a purchase length of 1.2 cm (arrowhead ‘1’); placement of transverse pass closer to lacerated tendon end to create a locking loop (arrowhead ‘2’). D: The third pass enters further from the lacerated end than the transverse pass to create a second locking loop (arrowhead ‘3’). The same passes are performed on the opposite tendon end to complete the first sequence of passes (4 strands now cross the repair site). E: Note that the suture limbs are exiting the radial and ulnar bundles of the tendon from their radial aspects (arrows); the second sequence of passes will utilize the ulnar half of the bundles to complete the 8-strand repair. F: Once the first sequence of passes is completed for the other tendon end, the ends are gently approximated to avoid ‘locking’ the ends apart prior to knot-tying.
Figure 3
Figure 3. FDP repair
A: Diagram depicting final repair and suture configuration. B: 4-0 looped Supramid suture. C: The initial pass is placed with a purchase length of 1.2 cm (arrowhead ‘1’); placement of transverse pass closer to lacerated tendon end to create a locking loop (arrowhead ‘2’). D: The third pass enters further from the lacerated end than the transverse pass to create a second locking loop (arrowhead ‘3’). The same passes are performed on the opposite tendon end to complete the first sequence of passes (4 strands now cross the repair site). E: Note that the suture limbs are exiting the radial and ulnar bundles of the tendon from their radial aspects (arrows); the second sequence of passes will utilize the ulnar half of the bundles to complete the 8-strand repair. F: Once the first sequence of passes is completed for the other tendon end, the ends are gently approximated to avoid ‘locking’ the ends apart prior to knot-tying.
Figure 3
Figure 3. FDP repair
A: Diagram depicting final repair and suture configuration. B: 4-0 looped Supramid suture. C: The initial pass is placed with a purchase length of 1.2 cm (arrowhead ‘1’); placement of transverse pass closer to lacerated tendon end to create a locking loop (arrowhead ‘2’). D: The third pass enters further from the lacerated end than the transverse pass to create a second locking loop (arrowhead ‘3’). The same passes are performed on the opposite tendon end to complete the first sequence of passes (4 strands now cross the repair site). E: Note that the suture limbs are exiting the radial and ulnar bundles of the tendon from their radial aspects (arrows); the second sequence of passes will utilize the ulnar half of the bundles to complete the 8-strand repair. F: Once the first sequence of passes is completed for the other tendon end, the ends are gently approximated to avoid ‘locking’ the ends apart prior to knot-tying.
Figure 3
Figure 3. FDP repair
A: Diagram depicting final repair and suture configuration. B: 4-0 looped Supramid suture. C: The initial pass is placed with a purchase length of 1.2 cm (arrowhead ‘1’); placement of transverse pass closer to lacerated tendon end to create a locking loop (arrowhead ‘2’). D: The third pass enters further from the lacerated end than the transverse pass to create a second locking loop (arrowhead ‘3’). The same passes are performed on the opposite tendon end to complete the first sequence of passes (4 strands now cross the repair site). E: Note that the suture limbs are exiting the radial and ulnar bundles of the tendon from their radial aspects (arrows); the second sequence of passes will utilize the ulnar half of the bundles to complete the 8-strand repair. F: Once the first sequence of passes is completed for the other tendon end, the ends are gently approximated to avoid ‘locking’ the ends apart prior to knot-tying.
Figure 4
Figure 4. Peripheral suture
6-0 Prolene is used in a running fashion, 2 mm deep and 2 mm from the lacerated end to improve the strength of the repair and tidy the repair site. The single core suture knot can be seen in the background.
Figure 5
Figure 5
Key points for the core and peripheral suture configuration.
See this image and copyright information in PMC

References

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    1. Lundborg G, Myrhage R, Rydevik B. The vascularization of human flexor tendons within the digital synovial sheath region--structureal and functional aspects. J Hand Surg. 1977;2A:417–427. - PubMed
    1. Sourmelis SG, McGrouther DA. Retrieval of the retracted flexor tendon. Journal of hand surgery (Edinburgh, Scotland) 1987;12:109–111. - PubMed
    1. Miller L, Mass DP. A comparison of four repair techniques for Camper's chiasma flexor digitorum superficialis lacerations: tested in an in vitro model. J Hand Surg. 2000;25A:1122–1126. - PubMed
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