[Primary flexor tendon suture].

Abstract

The protracted controversy about whether divided tendons, particularly in the so-called no-man's land, should be treated primarily or secondarily, seems to be resolved. Primary tendon suture with immediate dynamic splintage has led to a significant improvement in the results and is preferred, with minor variations, by most hand surgeons. Following a description of flexor tendon anatomy, more recent discoveries about the physiology of tendon healing are discussed. Developing from this, the currently used refined techniques of primary tendon repair are described. Particular attention is given to an exact description of post-operative supervision and management. Immediate tendon repair and subsequent treatment with dynamic splintage after Kleinert have considerable advantages for function, reduction of operating time and reduction of time off work. So-called secondary tendon repair after fresh, clean flexor tendon division should no longer be performed. Referral of patients with flexor tendon injuries, even from considerable distances, appears indicated, not only because of the better results but also for economic reasons. The previously published results are briefly described and critically reviewed.