Zone 2 digital flexor tendon repair surgical technique
Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.
Learn the Zone 2 digital flexor tendon repair surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Zone 2 digital flexor tendon repair surgical procedure.
Primary repair of a lacerated flexor tendon is a technically demanding procedure that requires careful exposure of the tendon ends with minimal disruption to adjacent structures, meticulous tissue handling and accurate coaptation with a robust suture repair.
A sound repair should therefore allow institution of an early active rehabilitation protocol allowing early tendon gliding, intrinsic healing with minimal scarring and restoration of normal finger motion. Most flexor tendon repairs are today performed by specialist hand surgeons working closely with hand therapists.
Each of Verdans flexor tendon zones has a unique set of anatomical considerations which the surgeon must be aware of.
The following technique demonstrates repair of a zone II laceration of flexor digitorum profundus (FDP).
This zone extends from the proximal margin of the A1 pulley to the insertion point of flexor digitorum superficialis (FDS). The zone is characterised by a tight fibro-osseous tunnel with closely related pulleys and a complex interweaving of tendons.
Sterling Bunnel called this area ‘no mans land’ alluding to the difficulty of primary repair here and historical results of attempted repair were all too often compromised by infection, dense scarring and loss of motion. Early surgeons therefore favoured acute wound closure and secondary tendon grafting of FDP. In the late 1960s however Kleinerts group published 87% good to excellent results of flexor tendon repair and this lead to a resurgence of primary repair.
The use of prophylactic antibiotics no doubt contributed to improved early results. However over recent decades, further refinements including the routine use of magnification, meticulous tissue handling, robust suture techniques and improved rehabilitation protocols, have all contributed to improved results of repair for these potentially devastating injuries.
Today multiple techniques of flexor tendon repair are in use according to individual surgeon preference. Each technique aims to appose the tendon ends with minimal gapping and a smooth repair site with preservation of tendon vascularity, and adequate strength to withstand rehabilitation protocols.
Author: Tahseen Chaudhry, Consultant in Hand and Peripheral Nerve Surgery
Institution: Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.