Flexor tendon repair in zone II with a new suture technique and an early mobilization program combining passive and active flexion

Abstract

A new epitendinal suture technique (cross-stitch) was used for flexor tendon repair in zone II in 46 consecutive patients with 55 injured digits. For the first 4 weeks after the operation, the digits were mobilized with a combination of active extension and passive and active flexion. Postoperative tendon excursions and gap formation were measured with intraoperatively placed metal markers. There were two ruptures. In the remaining digits, the mean active distal interphalangeal and proximal interphalangeal range of motion 6 weeks postoperatively was 50 degrees and 83 degrees, respectively. Six months postoperatively the corresponding figures were 63 degrees and 94 degrees. Three weeks postoperatively the mean tendon excursions per 10 degrees of joint motion varied from 82% (distal interphalangeal joint motion) to 88% (proximal interphalangeal joint motion) of the maximum possible. The results indicate that the cross-stitch is a reliable suture technique that, when used in combination with a program incorporating early active and passive flexion, can produce very good results after flexor tendon repair in zone II.