Flexor tendon suture according to Kirchmayr-Kessler

Anatomical orientation by palpation and marking of anatomical landmarks:

Brunner's incision in the area of the proximal and middle phalanx, integrating the scar. The planning also includes an access over the distal palmar crease, which does not need to be used in the further course.

Sharp transection of the skin.

Guiding structures

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

The skin and the subcutaneous tissue are detached in a flap-like manner from the flexor structures. Identification of the vascular/nerve bundle and the flexor tendon sheath.

Successive inspection of both neurovascular bundles, the flexor tendon sheath, as well as 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 dispensed with. The ulnar nerve and the radial neurovascular bundle are intact. The flexor tendon sheath is opened between the A2 and A3 annular pulleys, the deep flexor tendon (FDP) as well as the radial slip of the superficial tendon (FDS) are severed.