Complex Flexor Tendon Injury of the Fingers: A Case Report

Abstract

Flexor tendon injuries of the hand represent one of the most complex conditions in reconstructive surgery due to the functional importance of digital mobility and the intricate anatomy of the flexor apparatus. We present the case of a 32-year-old male patient with a history of a sharp trauma to the left hand secondary to an accident involving a cutting object. The patient presented with a zone I flexor injury of the second finger and zone II injuries of the third and fourth fingers, associated with complete section of the flexor digitorum profundus tendon of the second finger and complete section of both the flexor digitorum superficialis and flexor digitorum profundus tendons of the fourth finger. Clinically, the patient exhibited loss of active flexion, pain, and significant functional limitation. Surgical exploration and primary repair were performed using a multistrand modified Kessler tenorrhaphy technique reinforced with continuous epitendinous suture, preserving the pulley system and confirming adequate intraoperative tendon excursion. A protected early rehabilitation protocol was subsequently initiated, with satisfactory clinical evolution, proper wound healing, and progressive functional recovery of the affected fingers. Flexor tendon injuries continue to represent a major therapeutic challenge; however, timely treatment, appropriate surgical repair, and specialized rehabilitation significantly improve functional outcomes and reduce postoperative complications.