title: Outcomes of release of the entire A4 pulley after flexor tendon repairs in zone 2A followed by early active mobilization.
abstract: We report the outcomes of repair of the flexor digitorum profundus tendon in zone 2a in 22 fingers. The tendon was repaired with a six-strand repair method and the A4 pulley was completely released. Release of the C2 pulley combined with the A4 pulley was necessary in 12 fingers, nine fingers underwent a complete release of the A3, C2, and A4 pulleys, and one finger underwent a release of the C1, A3, C2, and A4 pulleys. The mean total active motion of the three finger joints was 234° at 5 to 12 months of follow-up. No bowstringing was noted in these fingers. The good and excellent recovery of active digital motion was in 20 (91%) out of 22 fingers according to Strickland's criteria or Tang's criteria. Our results suggest that release of the A3, C2, and A4 pulleys makes the repair surgery easier and does not cause tendon bowstringing.
authors.affiliation: Niigata Hand Surgery Foundation, Niigata, Japan kmoriya@k8.dion.ne.jp.
authors.forename: K
authors.initials: K
authors.lastname: Moriya
authors.affiliation: Niigata Hand Surgery Foundation, Niigata, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Yoshizu
authors.affiliation: Niigata Hand Surgery Foundation, Niigata, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Tsubokawa
authors.affiliation: Niigata Hand Surgery Foundation, Niigata, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Narisawa
authors.affiliation: Niigata Hand Surgery Foundation, Niigata, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Hara
authors.affiliation: Niigata Hand Surgery Foundation, Niigata, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Maki
mesh_terms: D000328:Adult; D005383:Finger Injuries / Q000534:rehabilitation* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011182:Postoperative Care; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D013536:Suture Techniques; D013708:Tendon Injuries / Q000534:rehabilitation* / Q000601:surgery*; D055815:Young Adult
keywords: A4 pulley; early active mobilization; flexor tendon injury; release; six-strand technique; zone 2