Delayed treatment of flexor tendon injuries including grafting.

This article synthesizes an enormous amount of peer reviewed articles, book chapters, and anecdotal clinical information regarding the late management of flexor tendon injuries by free-tendon grafting, tenolysis, and staged reconstruction. Some of the most pertinent historical contributions to these subjects have been reviewed in concert with an update regarding the most widely used current clinical methods for performing these procedures. This article points out areas of controversy and references the dissenting opinions from those presented here. The delayed treatment of flexor tendon injuries has advanced considerably in the last half century. Although much of the sage advice of the historic masters of flexor tendon surgery remains clinically applicable today, newer techniques and much improved therapy protocols have improved appreciably the results of the procedures described in this treatise. It is realistic and exciting to anticipate that the future will continue to improve the results of these methods through biologic manipulation of tendon healing and adhesion formation.