The main problem of flexor tendon surgery is the tendency for adhesions and scarring between the tendon and the flexor tendon sheath. The only feasible way to avoid such adhesions so far is the early movement of the tendon.
This requires a stable suture technique that must meet high standards.
Suture techniques where the thread encompasses the tendon fibers in such a way that pulling the suture closes the loop (locking suture) are significantly more stable (10–50%). A classic procedure of this type is the Kirchmayr-Kessler suture shown here (Fig. 1), where the threads are appropriately pierced during loop formation.
The tensile strength of this two-strand suture is sufficient to withstand the stress of passive rehabilitation. It is technically simple and thus well applicable in practice. However, a two-strand suture is not sufficient to withstand the stress of active rehabilitation without resistance. Therefore, for surgical success, dynamic Kleinert rehabilitation is mandatory, requiring the patient to have a sufficient degree of cooperation in the first weeks postoperatively.
This is always a critical point, and in recent decades, new suture techniques have been proposed (Fig. 2) that allow for higher stress.
These are technically more demanding and not without complications. Therefore, the classic Kirchmayr-Kessler suture remains the method of choice for many hand surgeons for the reconstruction of a severed flexor tendon.
The case shown here involves a 9-day-old cut injury at the ulnopalmar middle joint of the right ring finger in a young patient.