Zone 2 flexor tendon injuries: Venturing into the no man's land

Prakash P Kotwal, Mohammed Tahir Ansari, Prakash P Kotwal, Mohammed Tahir Ansari

Abstract

Flexor tendon injuries are seen commonly yet the management protocols are still widely debated. The advances in suture techniques, better understanding of the tendon morphology and its biomechanics have resulted in better outcomes. There has been a trend toward the active mobilization protocols with development of multistrand core suture techniques. Zone 2 injuries remain an enigma for the hand surgeons even today but the outcome results have definitely improved. Biomolecular modulation of tendon repair and tissue engineering are now the upcoming fields for future research. This review article focuses on the current concepts in the management of flexor tendon injuries in zone 2.

Keywords: Hand injuries; rehabilitation; tendon injuries; tendon repair.

Conflict of interest statement

Conflict of Interest: None.

Figures

Figure 1
Figure 1
Clinical photograph showing zones for localization of flexor tendon injury (Verdan)
Figure 2A
Figure 2A
Peroperative photographs showing (a) delivered ends of both the tendons in zone 2 (b) delivery of the distal ends by flexing the DIP joint (c) injured digital nerve, not an uncommon finding during the repair
Figure 2B
Figure 2B
Peroperative photographs showing (a) Meticulous repair of both the tendons and digital nerve (b) Good postoperative reults obtained with supervised physiotherapy
Figure 3
Figure 3
Line diagram showing (a) conventional two strand suture techniques (b) (a) conventional four strand suture techniques
Figure 4
Figure 4
Sketches of different types of the commonly used suture techniques for repair of the flexor tendon
Figure 5
Figure 5
Peroperative clinical photograph showing excessive scaring in neglected cases
Figure 6
Figure 6
Peroperative photograph showing (a) Well placed silicone rod at zone 2 along with the reconstructed pulleys (b) Silicone rod brought into proximal forearm (c) Silicone rod is replaced by a free tendon using two minimal incisions and rail-road technique

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