[Primary management of flexor tendon injuries of the hand]

Abstract

The repair of interrupted flexor tendons of the hand and their return to satisfactory function has been one of the most difficult and challenging tasks and problems even for the hand surgeon. Accordingly, nearly all publications have dealt with suture techniques, suture material and even the number of knots with regard to vascularization, course of sheaths and biology of healing. The aim of all surgical intentions is intrinsic healing, with as few adhesions as possible. On the one hand, this requires non-traumatic treatment of the tendon, respecting the dorsally located blood support and, on the other, early motion, jeopardizing the continuity of sutures. These diametrical requirements are the crux of flexor tendon surgery. Many authors-including-prefer a combination of Kleinerts intratendinously knotted suture with Ikuta's technique with the knot sunk below the tendon surface. Closure of the severed sheath is recommended, as is reconstruction of both tendons, provided that both are injured. The repair of partial lacerations is different, however. Kleinert's early motion treatment in the rubber-hand-protected flexion position is the postoperative management that has the most acceptance. In two consecutive follow-up studies (1974-1987 and 1988-1994) of 253 patients with 348 injured fingers, we achieved excellent and good results in 84.8% in the earlier group and in only 80.3% in the later one, which involved more surgeons with varying amounts of experience in hand surgery.