The five flexor tendon zones guide treatment decisions and predict outcomes. Zone II (no man's land — between the A1 pulley and the FDS insertion at the middle phalanx) contains both FDS and FDP in the tight digital sheath. Repairs here are most technically demanding and prone to adhesion formation. Early active motion protocols (modified Duran or Kleinert) reduce adhesion formation and improve outcomes.
Zone II is the most critical repair zone — both FDS and FDP in the tight fibro-osseous sheath require meticulous repair and controlled active motion to prevent adhesion formation
Zone II flexor tendon repair outcomes depend on: technique (minimum four-strand core suture of each tendon with epitendinous running suture), timing (within 5 days — the golden period), and rehabilitation (early active motion day 3-5). Total active motion (TAM) at 3 months is the primary outcome measure — greater than 75% of contralateral is excellent.
Critical zone flexor tendon repair requiring four-strand technique and early active motion rehabilitation to prevent adhesion formation.
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