Anatomical Repair of Zone 1 Flexor Tendon Injuries

Background: Repair and rehabilitation of the flexor digitorum profundus tendon in zone I may be demanding. The aim of the authors' study was to assess a new technique for reinsertion of the distal flexor digitorum profundus tendon. Methods: The authors' series consisted of 18 patients who required primary (n = 10) or secondary (n = 8) repair of the flexor digitorum profundus tendon in zone I. A half-Bruner incision was extended into the distal volar skin to expose the insertion site. Two drill holes were made through the base of the distal phalanx obliquely from the insertion of the profundus tendon in a dorsolateral direction. A modified Kessler suture was passed through the tendon and then through these holes and tied anteriorly, providing transosseous, internal fixation. Range of movement was assessed according to Moiemen's categories. Results: Fourteen patients had excellent or good results, two patients had fair results, and one patient had a poor result. One patient failed to complete physiotherapy and was lost to follow-up. No tendon rupture was documented during a mean follow-up period of 8 months. Conclusions: The authors' technique anchors the flexor digitorum profundus tendon or the graft in an anatomical position on the distal phalanx, without the need for external sutures or additional incisions. Furthermore, this is accomplished with minimal morbidity to the surrounding highly specialized tissue. The authors' results compare favorably with those of other techniques in the literature. (Plast. Reconstr. Surg. 123: 617, 2009.)