Principles of tendon repair

Tendon injuries in the hand are common; they are usually open injuries requiring surgical intervention. In this article we discuss tendon injuries in terms of approach to repair beginning at the time of diagnosis through to the rehabilitation programmes and outcome measures commonly used in the UK. In general tendon injuries should be considered using Verdan's zones for both extensor and flexor injuries. Flexor tendons require a high strength repair and usually warrant a core suture with epitendinous reinforcement bearing in mind the importance of not disrupting glide with unnecessary suture bulk. Extensor tendons more proximally can be treated in the same way but distally require only a running suture in the flattened tendon ends. All tendon injuries require a period of protected mobilization with splinting aiming to protect the repair but reduce stiffness in other joints.