Zone II Flexor Tendon Injury. Repairing "No Man's Land" to Optimize Results.

Proper tendon repair to achieve maximal results with zone II flexor tendon injuries requires strict compliance of the patient with hand therapy. It is of paramount importance to adhere to post-operative care to ensure that tendons glide appropriately through the pulley system so that after the tendon heals, proper excursion can be restored to the hand to maximize outcome.

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Hand & Microsurgery: Flexor Tedon Injuries

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While I enjoy all aspects of plastic and reconstructive surgery, hand and microsurgery are particularly enjoyable as the anatomical dissections closely resemble the diagrams in the text books. In fact, surgery of the hand is what stimulated my interest in plastic & reconstructive surgery.
It is important when repairing flexor tendons in zone II of the hand, to preserve the A2 and A4 pulleys. After fenestrations have been made in the synovium between the pulley system of the hand the injured flexor tendon can be easily identified. Occasionally I have found that the cruciate pulleys often need to be partially excised so that adequate purchase can be made on the flexor tendons to ensure a strong and durable repair.

Immediate post-operative mobilization with the Duran protocol is important to ensure adequate flexor tendon gliding.

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