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Flexor Tendon Repair

Zone II is a segment of anatomy in the hand from the mid-palm to the joint adjacent to the tip of the finger where the flexor tendons of each finger glide back and forth inside a tight segmental tunnel structure called the flexor tendon sheath, or pulley, system.  The complexity of repairing a tendon in Zone II is alluded to by the name given to this area by hand surgeons, “no man’s land.”

In essence, a tendon is like a rope, woven of individual collagen fibers.  As long as the tendon is inside the flexor tendon sheath and under some tension, the tendon is healthy.  When a lacerated tendon retracts outside the pulley system (flexor tendon sheath), the tendon swells and frays, such that it may be very difficult to place it back into its sheath.  Simultaneously, the empty flexor tendon sheath begins to contract, until after several weeks the sheath itself becomes practically obliterated.

In addition to lacerations, certain sports activities can cause flexor tendon injuries.  These injuries often occur in football, wrestling, and rugby.  “Jersey finger” is one of the most common of these injuries and can happen when one player grabs another’s jersey and a finger (usually the ring finger) gets caught and pulled, resulting in the tendon pulling off the bone.  Tendons and/or their sheaths can also be stretched or torn in sports requiring a great deal of arm and hand strength, such as rock climbing.

Certain health conditions, such as rheumatoid arthritis, weaken the flexor tendons and make them more likely to tear.  Oddly enough, this can happen without warning or injury – a person may simply notice that his or her finger no longer bends, but cannot recall how it could have happened.

Because tendons tear in different ways – such as straight across, at an angle, or pulled right off of the bone – there are many different methods for surgeons to repair them.  All the methods of repair, however, involve suturing the tendon back together.  Surgery is usually performed on an outpatient basis and patients are often encouraged to begin movement immediately.

TOBY is the world leader in flexor tendon repair, having developed the industry’s first ever tools for such surgeries.  The devices are intended to help the surgeon repair and/or reconstruct lacerated flexor tendons.  The pre-sterile kit contains two components: a transparent funnel retractor and a suture retriever / sheath dilation tool.  With the assistance of these tools, flexor tendon repair surgery can now be performed even up to 6 or 8 weeks after the initial injury; something previously unheard-of.