Zones I-III Repair

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TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Executes surgical walkthrough

  • describes the steps of the procedure verbally prior to the start of the case

2

Describes potential complications and steps to avoid them

F

Room Preparation

1

Surgical instrumentation

  • loupe magnification

2

Room setup and equipment

  • standard operating table
  • hand table

3

Patient Positioning

  • patient placed in the supine position with hand on hand table
  • place tourniquet high on the affected extremity
G

Zone I Repair

1

Expose the lacerated tendon

2

Perform primary repair of the tendon

  • place a running cross stitch or figure of eight stitch with 5-0 absorbable suture in the tendon
  • avoid shortening the tendon

3

Place a K wire

  • place the DIP joint in neutral
  • support the repair by placing a 0.045 inch Kwire across the DIP joint

4

Close the skin

H

Zone II Repair

1

Expose the lacerated tendon

  • use Bruner or midaxial incision

2

Bluntly dissect down to the lacerated tendon

3

Perform primary repair

  • perform primary tendon repair with a running 4-0 or 5-0 cross stitch suture

4

Close the skin

5

Stabilize the repair

  • splint the DIP joint or pin the joint in extension for 6 weeks
I

Zone III Primary Repair

1

Make a skin incision at the site of the repair

2

Expose the site of repair

  • bluntly dissect to the site of repair

3

Perform a primary repair of the central slip

  • use a running stitch with 4-0 or 5-0 suture to repair the central slip

4

Repair the lateral bands

  • repair the lateral band or bands with single 4-0 or 5-0 monofilament

5

Close the skin

J

Zone III Reconstruction in Cases with Tendon Loss

1

Choose type of procedure to perform

  • Consider v-y advancement of the central tendon or a turndown of the central slip proximal to the laceration to cover the defect

2

Make and extend the incision

  • extend the skin incision proximally almost to the MCP joint
  • incise a V in the central slip with the apex just distal to the MCP joint
  • make the distal end the width of the tendon
  • take care to not damage the overlying epitenon

3

Advance the tendon distally

  • minimize disruption to the loose alveolar tissue between the tendon and the periosteum as much as possible

4

Close the incised V

  • close the V into a Y with a 4-0 or 5-0 suture

5

Repair the distal end of the advanced central slip

  • use a running stitch with 4-0 or 5-0 suture for the repair

6

Close the skin

7

Immobilize the repair

  • use static splinting or pinning of the PIP joint in full extension
N

Wound Closure

Postoperative Patient Care
 

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