Flexor and Extensor Tendon Repair — Zones, Pulleys, Repair Strategy, and Rehabilitation

This episode reviews the core principles of flexor and extensor tendon repair, focusing on anatomy, tendon zones, repair technique, and rehabilitation.Topics include FDS and FDP anatomy, Camper’s chiasm, the Verdan flexor tendon zones, and the pulley system, with emphasis on preserving A2 and A4 to prevent bowstringing. The episode also reviews tendon blood supply through the vincula, intrinsic versus extrinsic healing, and why controlled motion is critical for tendon gliding.Flexor tendon repair is discussed through diagnosis, timing, partial lacerations, multi-strand core repair, epitendinous sutures, locking loops, early active motion, and salvage reconstruction with Hunter rods and tendon grafting. Key clinical concepts include the resting cascade, tenodesis effect, and prevention of the Quadriga effect.Extensor tendon injuries are reviewed by zone, including mallet finger, boutonniere deformity, fight bite injuries, sagittal band rupture, EPL rupture after distal radius fracture, and spaghetti wrist. Additional topics include the Elson test, juncturae tendinum, tendon transfers, operative repair sequence, and the role of WALANT for real-time assessment of tendon glide and repair tension.Part of Dr. Lara’s Plastic Surgery Compendium — a high-yield audio reference for plastic surgery trainees and surgeons. DisclaimerThis podcast is intended for educational purposes only and is designed for medical students, residents, fellows, and practicing healthcare professionals. It is not intended to provide medical advice, diagnosis, or treatment for any individual patient. The content presented reflects general surgical principles and should not be used as a substitute for formal medical training, clinical judgment, or consultation with qualified healthcare professionals. Listening to this podcast does not establish a physician–patient relationship.SEO / Topic Keywordsflexor tendon repair, extensor tendon repair, Verdan zones, flexor tendon zones, FDS, FDP, Camper chiasm, A2 pulley, A4 pulley, bowstringing, vincula tendon blood supply, intrinsic healing, extrinsic healing, early active motion, core suture, epitendinous suture, locking loop tendon repair, Quadriga effect, Hunter rod, tendon grafting, mallet finger, boutonniere deformity, Elson test, fight bite, sagittal band rupture, EPL rupture, EIP tendon transfer, spaghetti wrist, WALANT tendon repair