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this is Aaron Fralick and the following
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video shows a zone to flexor tendon
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repair of the FDS and FDP tendons of the
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fifth finger after laceration the
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original incision is opened and the
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sutures removed from the initial washout
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when the patient was seen in the
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emergency department and we plan our
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exposure to allow adequate visualization
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of the flexor tendon and through the
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zone of injury and repair of any
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structures as necessary these are done
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in burna fashion to prevent any
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contractures of the scar the zone of
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injury is entered and then we continue
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extending our approach to allow
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visualization of the lacerated tendons
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the flaps can be tapped back temporarily
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in the usual fashion allowed
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visualization careful dissection is then
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done to identify the lacerated flexor
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tendons here you see the FDP and then
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FDS tendons lacerated and retracted into
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the palm and a traumatic technique is
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used and handling the tendons is
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minimized as much as possible so a small
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gauge needle is used to temporarily fix
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these in place Joaquin de niro
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dissection identifying the distal stumps
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of the tendons for repair and the
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dissection is continued identifying the
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neurovascular bundles to ensure that
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they're not injured through the entire
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zone of injury
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once all structures are identified we
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can then proceed with the planned repair
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here you can see that the tendons had
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retracted distally underneath the a1 and
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part of the a2 pulley when we begin by
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placing our first core suture here in
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one of the two flexor tendons in a
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grasping fashion and then the second
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core suture is placed to allow for a
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four strand repair once the sutures are
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placed in both of the distal stumps the
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seizures can then be used to place the
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tendons back into the digital sheath and
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then repaired on the other side decision
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needs to be made at this point whether
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repairable tendons or whether to
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sacrifice the superficial flexors to
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allow adequate gliding of the deep
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flexor through the digital sheet both
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tendons are now proximal and the four
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strand core pair and core centers are
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then placed in the proximal stumps as
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well once we have all our sutures place
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we can then proceed with the remainder
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of the pair including an epic tendinous
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suture that's placed circumferentially
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here all of our core stands our strands
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are placed and we begin by placing the
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back wall epic and a suture using in a
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6-0 prolene
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while holding the 210 and ends together
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using our core seizures
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once the back wall has been completed
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the f10 of suture is left in place and
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we can begin time our core sutures first
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the central to core seekers are tied and
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cut and then the remaining two core
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searchers are tied in the same fashion
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the core features of hide the epidemic
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sutures once again continued
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circumferentially around the Bolar
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surface and then tied to the remaining
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stump in the same fashion this is
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completed for the other flexor tendon
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once the repair of both tendons has been
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completed we need to ensure that the
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tendons glide freely and that there's no
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impingement on each other or on the
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flexor tendon sheath in the finger full
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range of motion as them seen in the
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finger without any impingement on the
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pulley if there is any impingement of
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holy portions of it can be either step
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cut to open it or in size the ones then
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closed