The authors report on their technique for distal flexor digitorum profundus tendon repair that involves suturing the proximal end of the cut tendon to both the distal tendon stump and the DIP joint palmar plate with 3 figure-of-eight sutures. In the first part of their study, the tensile strength of the repair was investigated using 28 fresh flexor profundus tendons from the hind feet of adult sheep. Inclusion of the palmar plate in the suture construct was found to significantly strengthen the repair, with a mean load to failure of 112 N (more than twice the force encountered during active range of motion). In the second part of their study, 15 patients with clean-cut zone 1 lacerations underwent the repair technique and initiated active finger motion exercises postoperatively. At a minimum of 3 months after surgery, the mean range of motion at the DIP and PIP joints measured 66 degrees and 100 degrees, respectively. There were no tendon ruptures or infections.
Distal flexor profundus lacerations in zone I are commonly treated by tendon reinsertion into the distal phalanx. Available techniques include drill holes in the distal phalanx (with internally or externally placed sutures) and reattachment of tendon to bone using suture anchors. The procedure proposed by Al-Qattan and co-authors is applicable to a subset of zone I lacerations with small remnants of profundus tendon and volar plate still attached to bone. The load to failure data supports the possibility of early active finger motion. In addition, their technique avoids dorsal finger structures and the associated risk of injury to the nail bed.