This article defines a sensate, pedicled heterodigital flap from the proximal radial side of the index finger for reconstructing large soft tissue defects of the thumb. The pedicle consists of the radial digital artery of the index finger. Dorsal sensory branch of proper digital nerve and one of the terminal sensory branches of radial nerve are included in the flap for sensation. The results of 17 consecutive patients at 24 months revealed mean static two-point discrimination of 7 mm at the reconstruction site and 10 patients were able to feel 4 mm at the reconstructed thumb. The mean range of motion of metacarpophalangeal and interphalangeal joints of operated thumbs reached 94% and 66%, the mean grip span reached 96% compared with the uninjured side. The presented flap provided a simple yet favourable alternative for reconstruction of the thumb tip, with thick and durable tissue requiring minimum dissection and donor side morbidity. Level of evidence: IV.

ObjectiveThere has been no consensus in literature for the ideal flexor tendon repair technique. The results of zone 2 flexor tendon lacerations repaired primarily by 4 strand Modified Kessler core suture and epitendinous interlocking suture technique followed by Modified Kleinert protocol were investigated.Methods128 fingers of 89 patients who had flexor tendon laceration in zone 2 built the working group. Functional outcomes were evaluated using the Strickland formula. A statistical analysis was made between Strickland scores and some parameters such as age, gender, follow-up time, co-existing injury existence, repair time, single or multiple finger injury, tendon rupture and the effect of FDS injury and repair.ResultsExcellent, good, fair, poor results were obtained from 71 (55.5%), 46 (35.9%), 8 (6.3%), 3 (2.3%) fingers, respectively. Time of the repair has a significant effect on the strickland scores. Surgery performed within the first 24 hours following the injury gave better results. 3 fingers (2.3%) had tendon ruptures. Existence of ruptures affected the results significantly. Co-existing injuries were found that they did not have any effect on the results. In the fingers in which both FDP and FDS tendons were lacerated, no significant relationship was found between only FDP repair, both FDP and FDS repair and single FDS slip repair. Additionally no significant relationships between follow-up time, gender, single or multiple finger injury and Strickland scores were observed. 13 fingers (10.1%) had PIP joint contracture above 20°.ConclusionThe low rupture rate (2.3%) and 91.4% ‘good’ and ‘excellent’ scoring rates in our series support the idea that modified Kessler 4-strand core suture and epitendinous interlocking suture repair combined with modified Kleinert protocol gives satisfactory results. Repair time is one of the most important factors affecting the functional results and surgery should not be delayed if there is an experienced surgeon available.Level of evidenceLevel IV, therapeutic study.

A proper suture technique combined with the short arc motion protocol provides good results in the treatment of isolated zone 3 extensor tendon injuries.