The successful reconstruction of tendon injuries, especially on the flexor side of the fingers and hand mirrors the history of hand surgery. Until the middle of the last century, the primary tendon suture for tendon injuries of the hand and fingers was not necessarily the method of choice. This was particularly true for certain regions of the hand such as the flexor surface of the fingers (“no man’s land”). In the 1960s, reports began to be published demonstrating the feasibility and in fact desirability of primary tendon repair. Since that time there was great progress in understanding the biology and anatomy of the tendons, the biological responses to tendon injuries, and methods of tendon suture. Technological improvements in suture materials and methods of rehabilitation also contributed to making the primary tendon repair in “no man’s land” the operative procedure of choice. The goals of surgical treatment of tendon injuries of the hand and fingers are the exact and sufficiently strong coaptation of the tendon ends in a way that the application of state-of-the-art post-operative rehabilitation protocols allow early active motion exercises. Those protocols (e. g. Kleinert or Duran) are in fact the crux of the matter. Without them the most expertly conducted tendon repair will likely result in a stiff finger whereas strict adherence to them plus an expert repair gives a high chance of reasonably normal motion after tendon injury in “no man’s land”.
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