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Introduction: The authors present a protocol for primary tendon repair and early active motion, to prevent adhesions, mainly in Zones I and II. The authors used a method for tendon-repair tension relief, with a dynamic anchoring pull-out loop, interconnecting and bow-stringing the proximal part of the tendon to the distal phalanx, allowing early active motion. Previous comparative biomechanical data has suggested a considerably higher resistance suture, with a similar technique.

Patients, Methods, and Procedures: From 2000 to 2008, 20 patients were treated: A protocol registered their age, profession, affected and dominant sides, injured fingers, associated lesions, nerves, FDS tendon, time elapsed from injury to treatment and  mobilization. The inclusion criteria were: adults with recent, untreated tidy wounds and with FDP lesions in Zones I and II, nimble joints and no other associated lesions or arthritis.

Under adequate anaesthesia and tourniquet control, the wound is exposed, inspected and the pulleys are preserved whenever possible. The tendon stumps are sutured using Kessler´s modified technique, with a 4/0 monofilament nylon core-stitch and a 6/0 nylon, circumferential running suture. The tension relieving 3/0 nylon pull-out loop  with  a 25mm, sharp needle, anchors the proximal part of the tendon to the distal phalanx, under tension. The loop suture starts on the nail plate at  2mm from its lateral border, bypassing the bone. The needle surfaces at the distal portion of the surgical wound or, through the skin at the pulp´s mid-line and once again, re-enters the same hole to exit at the distal portion of the wound. The suture thread should then run parallel to the tendon and freely into the osteofibrous pulleys.

Results: In the functional evaluation at the 6th postoperative month, all 19 patients attained pulp-to-palm flexion, up to 2 cm from the distal palmar crease. No infection or nail plate deformity was found and the postoperative period was well tolerated by all cases. In one patient, early removal of both stitches and loop was at the 3rd week and in another patient a tenolysis was indicated for DIP contraction.

Conclusion: The preliminary results are encouraging and the method permits early motion with no significant complications.