Year Book: Flexor Digitorum Profundus and Flexor Pollicis Longus Repair by
the "Rope Down" Technique: Results of a Series of 77 Cases. Marin, Braun F. Foucher, G. Buch, Jaeger N. Sammut, D. Abstract/Commentary:|1992 Year Book of Hand Surgery. Article 6-4.|Original Article:|Ann Chir Main. 1991. 10. pp 13-21.. Introduction.--Few published reports deal exclusively with the repair of digital flexor tendon lesions located in zone I. Most authors do not differentiate between zone I and zone II lesions when reporting their results. Some authors are of the opinion that zone I lesions need not be repaired at all, particularly when the lesion is diagnosed late. The authors report their results with the Jennings barb-wire suture in a series of patients with zone I flexor tendon injuries. Patients.--Between 1978 and 1988, 104 patients with zone I flexor tendon injuries were operated on at this institution, 81 of whom were evaluable. Four children under 15 years of age were excluded from this analysis. The remaining 77 patients made up the study population. There were 59 males and 18 females, aged 15-64 years, 34 of whom (44.1%) were manual laborers. Most injuries were the result of accidents in the home. Twenty patients had thumb injuries, and 57 had injured a long finger. Forty-three patients (55.8%) underwent emergency operation. All patients were treated in the ambulatory surgery unit. All flexor tendons were reinserted by the rope-down technique, using the Jennings barbed -wire suture (Fig 6-4). Follow-up ranged from 3 months to 10 years. Seventy of the 77 patients received immediate hand therapy and were instructed to perform 3-4 movements every hour. A splint was worn between exercises for 4 weeks after operation to protect the finger. Results.--Fourteen patients (18.2%) had complications, 2 of whom required secondary tenolysis. Mobility of the metacarpophalangeal joint and the proximal interphalangeal joint was maintained in all but 1 case. The mean active flexion achieved at the level of the distal interphalangeal joint was 42.8 degrees, and the mean extension deficit was 5.5 degrees. Analysis of factors that may interfere with a favorable outcome identified only the presence and extent of associated injuries as prognostic factors affecting the outcome. The average time away from work for manual laborers was 6.9 weeks. Conclusion.--The barbed -wire suture is a simple, rapid technique for achieving secure tendon reinsertion for zone I flexor tendon lesions. The functional outcome is good, and the technique allows immediate active mobilization.
Original Text by Clifford R. Wheeless, III, MD.
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