We report the outcomes of repair of the flexor digitorum profundus tendon in zone 2a in 22 fingers. The tendon was repaired with a six-strand repair method and the A4 pulley was completely released. Release of the C2 pulley combined with the A4 pulley was necessary in 12 fingers, nine fingers underwent a complete release of the A3, C2, and A4 pulleys, and one finger underwent a release of the C1, A3, C2, and A4 pulleys. The mean total active motion of the three finger joints was 234° at 5 to 12 months of follow-up. No bowstringing was noted in these fingers. The good and excellent recovery of active digital motion was in 20 (91%) out of 22 fingers according to Strickland’s criteria or Tang’s criteria. Our results suggest that release of the A3, C2, and A4 pulleys makes the repair surgery easier and does not cause tendon bowstringing.
DoyleJRBlytheW. The finger flexor tendon sheath and pulleys: anatomy and reconstruction. In: American Academy of Orthopaedic Surgeons Symposium on tendon surgery in the hand. St. Louis, CV Mosby, 1975: 81–7.
2.
ElliotDGiesenT. Primary flexor tendon surgery: the search for a perfect result. Hand Clin. 2013, 29: 191–206.
3.
FrankoOILeeNMFinneranJJ. Quantification of partial or complete A4 pulley release with FDP repair in cadaveric tendons. J Hand Surg Am. 2011, 36: 439–45.
4.
KleinertHEBennettJB. Digital pulley reconstruction employing the always present rim of the previous pulley. J Hand Surg Am. 1978, 3: 297–8.
5.
Kwai BenIElliotD. “Venting” or partial lateral release of the A2 and A4 pulleys after repair of zone 2 flexor tendon injuries. J Hand Surg Br. 1998, 23: 649–54.
6.
LinGTCooneyWPAmadioPCAnKN. Mechanical properties of human pulleys. J Hand Surg Br. 1990, 15: 429–34.
7.
LowrieAGLeesVC. Considerations in the surgical use of the flexor sheath and pulley system. J Hand Surg Eur. 2014, 39: 54–9.
8.
MitsionisGBastidasJAGrewalRPfaeffleHJFischerKJTomainoMM. Feasibility of partial A2 and A4 pulley excision: effect on finger flexor tendon biomechanics. J Hand Surg Am. 1999, 24: 310–4.
9.
MoiemenNSElliotD. Primary flexor tendon repair in zone 1. J Hand Surg Br. 2000, 25: 78–84.
10.
MoriyaKYoshizuTMakiYTsubokawaNNarisawaHEndoN. Clinical outcomes of early active mobilization following flexor tendon repair using the six-strand technique: short- and long-term evaluations. J Hand Surg Eur. 2015, 40: 250–8.
11.
SavageR. The mechanical effect of partial resection of the digital fibrous flexor sheath. J Hand Surg Br. 1990, 15: 435–42.
12.
StricklandJW. Flexor tendon repair. Hand Clin. 1985, 1: 55–68.
13.
StricklandJWGlogovacSV. Digital function following flexor tendon repair in Zone II: a comparison of immobilization and controlled passive motion techniques. J Hand Surg Am. 1980, 5: 537–43.
14.
TangJB. Indications, methods, postoperative motion and outcome evaluation of primary flexor tendon repairs in zone 2. J Hand Surg Eur. 2007, 32: 118–29.
15.
TangJB. Levels of experience of surgeons in clinical studies. J Hand Surg Eur. 2009, 34: 137–8.
16.
TangJB. Outcomes and evaluation of flexor tendon repair. Hand Clin. 2013, 29: 251–9.
17.
TangJB. Release of the A4 pulley to facilitate zone II flexor tendon repair. J Hand Surg Am. 2014b, 39: 2300–7.
18.
TangJBShiD. Subdivision of flexor tendon “no man’s land” and different treatment methods in each sub-zone. A preliminary report. Chin Med J. 1992, 105: 60–8.
19.
TangJBXieRG. Effect of A3 pulley and adjacent sheath integrity on tendon excursion and bowstringing. J Hand Surg Am. 2001, 26: 855–61.
20.
TangJBChangJElliotDLalondeDHSandowMVögelinE. IFSSH Flexor Tendon Committee report 2014: from the IFSSH Flexor Tendon Committee (chairman: Jin Bo Tang). J Hand Surg Eur. 2014a, 39: 107–15.
21.
VerdanC. Practical considerations for primary and secondary repair in flexor tendon injuries. Surg Clin North Am. 1964, 44: 951–70.
22.
WidstromCJDoyleJRJohnsonGManskePRMcGeeR. A mechanical study of six digital pulley reconstruction techniques: Part II. Strength of individual reconstructions. J Hand Surg Am. 1989, 14: 826–9.
23.
WuYFTangJB. Recent developments in flexor tendon repair techniques and factors influencing strength of the tendon repair. J Hand Surg Eur. 2014, 39: 6–19.
24.
YoshizuT. Immediate mobilization following flexor tendon repair (in Japanese). J Musculoskelet Syst. 1996, 9: 881–90.
25.
YoshizuTMakiYTsubokawaNIwabuchiYZenzaiK. Role of A4 pulley in primary flexor tendon repair and early mobilization exercise in zone I (in Japanese). J Jpn Soc Surg Hand. 1999, 15: 781–5.
