title: Modified Brunelli pull-out technique in flexor tendon repair for zone II: a study on 58 cases.
abstract: BACKGROUND
  The reconstruction of the continuity of flexor tendons disruptions in zone II still remains one of the most challenging problems in hand surgery. The ideal repair has to provide sufficient strength and the possibility of early mobilization in the attempt to obtain a functional range of motion. One of the methods which appears to respond to these requests is the pull-out technique described by Brunelli, which moves the tension from the level of the tendon disruption to the finger pulp over the tendon insertion.
  
  
  METHODS
  After using this method, but by doing some modifications of the original technique, our aim was to conduct a retrospective study looking at gap formation, suture strength, rupture rate, efficiency of the two-strand suture repair and of the early active mobilization against resistance in obtaining a good range of flexion rate. We reviewed a series of 71 flexor digitorum profundus disruptions in zone II, in 58 patients admitted in our service between 2000 and 2008, and treated with this method.
  
  
  RESULTS
  We achieved a complete range of flexion in 41 fingers (57.7%) and a flexion deficit of 5-10° in eight fingers (11.3%) and of 10-20° in 22 fingers (31%). We had no ruptures, major strength deficit, or bowstringing.
  
  
  CONCLUSIONS
  Our study demonstrates that, by moving the tension from the level of disruption to the finger pulp, the rehabilitation program can begin very early post surgery. We had 0% ruptures.
authors.affiliation: Clinic for Plastic Surgery and Reconstructive Microsurgery, Hospital for Rehabilitation, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Alexandru Valentin
authors.initials: AV
authors.lastname: Georgescu
authors.forename: Ileana R
authors.initials: IR
authors.lastname: Matei
authors.forename: Irina M
authors.initials: IM
authors.lastname: Capota
authors.forename: Filip
authors.initials: F
authors.lastname: Ardelean
authors.forename: Octavian D
authors.initials: OD
authors.lastname: Olariu