In Zone II flexor tendon injuries of the hand (no man's land), the preferred repair technique and postoperative regimen recommended for best outcomes is:

• A Single-strand repair followed by cast immobilization for 6 weeks
• B Primary repair is contraindicated; staged tendon grafting is always needed
• C 4-strand (or stronger) core repair plus epitendinous suture, followed by early active mobilization ✓
• D Pulley venting and tendon repair with 3 weeks immobilization

Explanation

Modern management of Zone II (between A1 pulley and FDS insertion) flexor tendon injuries employs a strong multi-strand core suture (4-6 strands, e.g., modified Kessler, cruciate, or Savage technique) combined with a circumferential epitendinous suture to increase strength and reduce gapping. Early controlled active mobilization (EAM) protocols significantly reduce adhesion formation and improve final range of motion compared to immobilization. 4-strand repairs withstand early active mobilization forces (approximately 6-7 N). Single-strand repairs with immobilization are associated with high rates of adhesion and inferior outcomes.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.