Development of flexor tendon surgery: twenty-five years of progress.

Abstract

Regaining satisfactory digital function after flexor tendon laceration and repair within the digit has long been one of the most difficult problems in hand surgery. Until the 1960s it was universally recommended that tendons divided in the digit (then referred to as “no man's land”) should not be repaired. Bunnell taught that “it is better to remove the tendons entirely from the finger and graft in new tendons smooth throughout its length.” 1 Bunnell S. Repair of tendons in the fingers and description of two new instruments. Surg Gynecol Obstet. 1918; 26: 103-110 Google Scholar That dictum remained sacrosanct until the 1960s when reports by Verdan, 2 Verdan CE. Primary repair of flexor tendons. J Bone Joint Surg. 1960; 42A: 647-657 Crossref Google Scholar , 3 Verdan CE. Practical considerations for primary and secondary repair in flexor tendon injuries. Surg Clin North Am. 1964; 44: 951-970 PubMed Google Scholar Kleinert et al, 4 Kleinert HE Kutz JE Ashbell TS Martinez E. Primary repair of lacerated flexor tendons in “no man's land.”. J Bone Joint Surg. 1967; 49A (abstr): 577 Google Scholar and Kessler and Nissim 5 Kessler I Nissim F. Primary repair without immobilization of flexor tendon division within the digital sheath: an experimental and clinical study. Acta Orthop Scand. 1969; 40: 587-601 Crossref PubMed Scopus (0) Google Scholar challenged the concept that flexor tendons should not be repaired primarily. These investigators noted that when done correctly, immediate tendon suture would outperform secondary free tendon grafting. Armed by those encouraging reports, there was a gradual and cautious development of the concept and practice of primary flexor tendon repair. Initially, primary tendon repair was often combined with anecdotal protocols by Duran et al, 6 Duran RJ Houser RG Coleman CR Stover MG. Management of flexor tendon lacerations in zone 2 using controlled passive motion postoperatively. in: Tendon surgery in the hand. : CV Mosby, St Louis1978: 178-182 Google Scholar Lister et al, 7 Lister GD Kleinert HE Kutz JE Atasoy E. Primary flexor tendon repair followed by immediate controlled mobilization. J Hand Surg. 1977; 2: 441-451 Abstract Full Text PDF PubMed Google Scholar and Strickland and Glogovac 8 Strickland JW Glogovac SV. Digital function following flexor tendon repair in zone II: a comparison of immobilization and controlled passive motion techniques. J Hand Surg. 1980; 5: 537-543 Abstract Full Text PDF PubMed Google Scholar for applying varying amounts of early post-repair motion to the repaired tendons.