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Repair of FDP Lacerations

- See:
      - Rupture of FDP
      - Flexor Tendon Repair
              - Staged Tendon Reconstruction:
              - Tendon Repair Technique:
              - Zone I Injuries
              - Zone II injuries
              - Zone III injuries
              - Zone IV and Zone V:
      - Tendon Sheath Anatomy


- Discussion:
    - skin laceration may not coincide with the point of tendon laceration
    - primary repair is performed if the wound is clean;
    - repair may be delayed seven to 21 days or even as long as six weeks after the original laceration;
    - tendon is mobilized proximally, annular ligaments are maintained & tendon is advanced distally & sutured to distal stump by end to end
          suture or by advancement if the distal stump is one cm long or less;
          - advancement greater than one cm causes contracture;
          - avoid lumbical plus finger:
    - excessive advancement of FDP tendon to long, ring, or little fingers results in extension deficit of that finger;
          - loss of flexion of the adjacent, uninjured digits is also noted;
          - index finger is not generally affected by FDP tendon advancement in long, ring, & little
                fingers because it usually exists as independent muscle belly;
    - maximum tolerated advancement in the long, ring, and little fingers is 1 cm and is 1.5 cm in the index finger;

- Relative Contra-Indications for FDP Repair:
    - rupture of previously repair FDP;
    - elderly or non-compliant patient who will not tolerate prolonged rehabilitation;
    - neglected zone II injury (this requires staged repair)
    - arthritic DIP joint;
    - A4 pulley rupture;

- Conversion to Superficialis Finger:
    - hyper-extension deformity is prevented by tenodesis of FDP tendon;
    - superficalis finger is fairly well tolerated;

- Post Operative Care: