Flexor tendon suture according to Kirchmayr-Kessler

Anatomical orientation through palpation and marking of anatomical landmarks:

Brunner's incision in the area of the proximal and middle phalanx, with the scar being integrated. The planning includes an approach over the distal palmar crease, which does not necessarily need to be used further.

Sharp incision of the skin.

Guiding structures

• Scar
• Proximal phalanx flexion crease
• Middle joint flexion crease
• Distal palmar flexion crease

The skin and subcutaneous tissue are flap-shaped and detached from the flexor-side structures. Identification of the vascular/nerve bundle and the flexor tendon sheath.

Successive inspection of both vascular/nerve bundles, the flexor tendon sheath, and its contents (FDS, FDP). In the present case, the ulnar digital artery is severed. Since the injury is 9 days old and has not led to any circulatory disturbance of the finger, reconstruction is omitted. The ulnar nerve and the radial vascular/nerve bundle are intact. The flexor tendon sheath is opened between the A2 and A3 pulley, the deep flexor tendon (FDP) and the radial slip of the superficial tendon (FDS) are severed.