Advances and Challenges in Zone 2 Flexor Tendon Repairs

Abstract

Flexor zone 2 is the area between the A1 pulley at the distal palmar crease to the insertion of the flexor digitorum superficialis tendon at A4 pulley. Termed “no man's land,” primary repair at zone 2 had notoriously high rate of complications such as adhesions, contractures, and tendon rupture. Improved understanding of tendon healing, stronger suture materials, novel operative techniques, judicious pulley venting, and early active rehabilitation have helped improve outcomes. This review examines current methodologies and postoperative considerations for zone 2 flexor tendon repair.