Diagnosis and Surgical Principles in the Treatment of Acute Injuries of the Flexor Tendons of the Hand

Injuries to the flexor tendons of the wrist are a separate chapter in wrist surgery. Flexor tendon injuries still remain a challenge to ensure the patient's optimal outcome. A special problem in the exploration of hand injuries is the accurate assessment of whether there is an injury to one or more tendons, at what height the injury is, and whether it is accompanied by injury to other elements of the hand. On the volar side of the hand, both flexors of the fingers, superficial and deep, or just one of them, maybe injured. If the lesion is in the first zone depending on the severity of the injury, reinsertion or direct tenography is required. In the second zone, there are still ambiguous views on the reconstruction of the deep and superficial flexor, ie. whether the surface flexor needs to be reconstructed. Injury to the flexor tendons in the third zone requires careful exploration for possible injury to the neurovascular elements, and the fourth zone often requires the release of the carpal tunnel. In the most proximal zone of the flexor tendons, the fifth zone, injury to the main blood vessels of the hand and the nerves responsible for sensitive and motor innervation of the hand is possible. Each injury should be approached with careful preoperative examination, appropriate operative technique as well as postoperative rehabilitation in order to fully restore the function of the hand.