- History and Physical Examination
- What are the key elements of the patient’s history to ask when assessing a patient with a suspected flexor tendon injury?
- What are you looking for on a physical exam?
- Surgical technique and timing
- What is the time frame for surgical repair of isolated flexor tendon injuries
- Method of repair – modified Kessler vs. cruciate vs. M-tang
- Number of core sutures
- Where to place knot? Outside vs. inside
- Suture type
- The role of epitendinous suture
- What type of suture, how far from the repair site
- What are your techniques for proximal tendon retrieval if it has retracted away from the site of injury?
- Do you perform flexor tendon repairs under wide-awake local anesthesia, no tourniquet (WALANT)? Do you find it’s easier to set the correct tension with an interactive patient?
- What is your preferred technique for chronic flexor tendon lacerations- pedicled FDS, palmaris, plantaris etc.
- What is a reasonable expectation in terms of ROM after a 2-stage flexor tendon repair
- Specific types of flexor tendon injuries based on Zone
- Jersey finger- when do you repair, do you use suture anchors if there’s a small distal stump
- Chronic- DIP fusion vs 2-stage repair
- Zone 2 – how much do you vent the pulleys, concern for bowstringing
- Are there circumstances in which you think it’s important to repair partial lacerations (< 50%)
- Postoperative care
- What is your typical postoperative rehabilitation plan? Does the rehab protocol differ depending on number of core sutures or zone of injury
- Complications
- Adhesions
- Timing of tenolysis if patients have limited movement after initial repair?
- Have you found that there are any patient or operative factors that increase the likelihood of rupture
- Memorable case/good save regarding flexor tendon repair?
- Favorite hand procedure
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