• Christine Stephan, Ali Saalabian, Jörg van Schoonhoven, and Karl-Josef Prommersberger.
• Klinik für Handchirurgie Herz- und Gefässklinik, Salzburger Leite 1, Bad Neustadt/Saale. c.stephan@handchirurgie.de
• Oper Orthop Traumatol. 2008 Mar 1;20(1):44-54.

ObjectiveFlexor tendon repair by direct suture, providing tendon function and mechanical properties and allowing postoperative active extension and flexion.IndicationsFlexor tendon laceration in all zones, when primary healing and a good functional outcome can be expected.ContraindicationsFlorid and chronic infection. Lack of skill, instruments, or manpower. Tension-free suture is not feasible. Severe soft-tissue problems. Mantero suture in case of coexistent artery injury.Surgical TechniqueHand surgical incisions and approach to the tendon. Opening of the tendon sheath in the region of oblique pulley. A four-strand core suture consisting of two locked two-strand sutures and a circumferential epitendon cross-stitch suture are performed. Lacerations in zone I with a tendon stump shorter than 1 cm require a Mantero suture and avulsions require a pull-out suture technique.Postoperative ManagementActive flexion and active extension in a dorsal wrist cast.ResultsThe clinical outcome studies after repair of zone II flexor tendon injuries using a multiple-strand suture technique describe 69-96% excellent and good results.

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