Current state of flexor tendon surgery.

Successful restoration of function after flexor tendon injuries continues to present a challenge to the treating surgeon. Primary repair of tendon and associated injuries is the treatment of choice in clean wounds in all zones of the hand. In cases of untidy wounds or when associated injuries preclude primary repair, delayed primary or secondary repair may be performed. Tendon grafting in one or two stages is reserved for late secondary cases in which scarring of the bed, loss of pulleys, permanent retraction of the tendon ends, or joint contractures prevent direct repair. Meticulous attention to detail such as adequate exposure, careful opening and closing of the sheath, gentle handling of the tendons, a secure, smooth tendon juncture and proper postoperative splinting is essential for a successful outcome of direct repair. Tendon grafts done as a secondary procedure require the same attention to minutiae for an adequate functional outcome.