Flexor Tendon Repair: Strength, Glide, and Early Motion

Flexor tendon repair succeeds only when construct strength, tendon glide, pulley preservation, and rehabilitation are planned as one system. In this episode of Plastics in Practice, we review the evaluation, zone-based strategy, repair principles, rehabilitation, complications, and salvage of flexor tendon injuries. Key takeaways:• Detect loss of the normal cascade or tenodesis effect, test flexor digitorum profundus and superficialis independently, and document neurovascular status.• Let the injury zone drive exposure and repair; zone II demands especially careful sheath and pulley management.• Build a strong, smooth multistrand repair with accurate tendon-end coaptation and no obstructive bulk at the repair interface.[1,2]• Preserve the critical A2 and A4 pulleys when possible, and vent judiciously when needed to restore free tendon glide.[1,2]• Begin therapist-directed protected motion early when the construct, associated injuries, and patient factors permit. The 2026 IFSSH consensus favors true early active flexion, whereas a 2024 randomized trial found better five-year motion after passive mobilization with place-and-hold; protocol choice remains debated and should be individualized.[1-3]• Recognize adhesions, gapping or rupture, bowstringing, quadriga, lumbrical-plus, and the situations that require grafting or staged reconstruction. This content is for educational purposes only and is not medical advice. 🎧 Full episodes available now:Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ 📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ #FlexorTendonRepair #HandSurgery #TendonRepair #PlasticSurgeryEducation #SurgicalPearls #PlasticsInPractice References:1. Miller EA, Teal L. Principles for achieving predictable outcomes in flexor tendon repair. Clin Plast Surg. 2024;51(4):445-457. doi:10.1016/j.cps.2024.02.0112. Tang JB, Lalonde D, Fernandes CH, Sadek AF, Besmens IS. The IFSSH consensus and current guidelines on flexor tendon repairs and reconstruction. J Hand Surg Eur Vol. 2026;51(2):127-138. doi:10.1177/175319342514048213. Chevalley S, Wängberg V, Åhlén M, Strömberg J, Björkman A. Passive mobilization with place-and-hold versus active mobilization therapy after flexor tendon repair: 5-year minimum follow-up of a randomized controlled trial. J Hand Surg Am. 2024;49(12):1165-1172. doi:10.1016/j.jhsa.2024.08.011