Research Article| Volume 72, ISSUE 4, P622-627, April 2019

Endoscopic retrieval of retracted flexor tendons: An atraumatic technique

Published:January 14, 2019DOI:



      The repair of retracted flexor tendons is a challenging problem for hand surgeons. The tendon stump should be handled in an atraumatic manner because any microtrauma to the sheath and tendon can lead to poor functional outcomes.


      Twenty-three patients with flexor zone 2 injuries and intraoperative finding of retracted tendons were randomly divided into two groups: endoscopic retrieval group and proximal incision group. A flexible endoscope and a flexible grasping forceps were used for endoscopic retrieval of the retracted flexor tendons. The groups were compared in terms of infection rate, neurovascular complications, regional pain, total range of active motion (TAM) and functional outcomes.


      Age, gender, average preoperative pain and general pain perception scores were similar between the two groups. We found a significantly shorter duration of operation and better pain scores at 1–2 weeks in the endoscopic group than in the other group (p = 0.002 and p = 0.020, respectively). A significant difference in TAM was demonstrated between the groups at 3 to 5 weeks (p = 0.003).


      The surgical procedure presented here has the advantages of direct visibility of the proximal tendon end and retrieval in an atraumatic manner, with better results and decreased morbidity. It is a promising approach and can be used as a routine procedure in retracted tendon cases.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Strickland J.W.
        Flexor tendon injuries: I. Foundations of treatment.
        J Am Acad Orthop Surg. 1995; 3: 44-54
        • Strickland J.W.
        Flexor tendon injuries: II. Operative technique.
        J Am Acad Orthop Surg. 1995; 3: 55-62
        • Holm C.L.
        • Embick R.P.
        Anatomical considerations in the primary treatment of tendon injuries of the hand.
        J Bone Joint Surg Am. 1959; 41: 599-608
        • Rice J.
        • Yanni D.
        The reversed esmarch tourniquet technique for the retrieval of cut flexor tendons.
        J R Coll Surg Edinb. 1995; 40: 419-420
        • Kamath B.J.
        • Bhardwaj P.
        A simple, semirigid, and surgeon-friendly tendon retriever and flexor sheath dilator.
        J Hand Surg Am. 2007; 32: 269-273
        • Pennington D.G.
        Atraumatic retrieval of the proximal end of a severed digital flexor tendon.
        Plast Reconstr Surg. 1977; 60: 468-469
        • Morris R.J.
        • Martin D.L.
        The use of skin hooks and hypodermic needles in tendon surgery.
        J Hand Surg Br. 1993; 18: 33-34
        • Iwuagwu F.C.
        • Gupta A.
        A simple tendon retrieval method.
        J Hand Surg Br. 2004; 29: 191-193
        • Hettiaratchy S.
        • Titley G.
        Flexor tendon retrieval: another trick.
        Plast Reconstr Surg. 2002; 109: 2156-2157
        • Sourmelis S.G.
        • McGrouther D.A.
        Retrieval of the retracted flexor tendon.
        J Hand Surg Br. 1987; 12: 109-111
        • Titley O.G.
        A modification of the catheter method for retrieval of divided flexor tendons.
        J Hand Surg Br. 1996; 21: 391-392
        • Kilgore Jr., E.S.
        • Adams D.R.
        • Newmeyer W.L.
        • Graham W.P.
        Atraumatic flexor tendon retrieval.
        Am J Surg. 1971; 122: 430-431
        • Adeniran A.
        • Babar A.Z.
        A relatively atraumatic method of retrieving retracted digital flexor tendons.
        J Hand Surg Br. 1997; 22: 122-124
        • Abouzahr M.K.
        Retrieval of the retracted flexor tendon.
        Plast Reconstr Surg. 1995; 96: 457-460
        • Li K.
        • Banducci D.R.
        • Kahler S.H.
        • Hauck R.M.
        • Mackay D.R.
        • Manders E.K.
        Endoscopic retrieval of severed flexor tendons.
        J Hand Surg Am. 1995; 20: 278-279
        • Hill B.B.
        • Wells M.D.
        • Prevel C.D.
        Endoscopic retrieval of severed flexor tendons: a study of technique using cadaveric hands.
        Ann Plast Surg. 1997; 38: 446-448
        • Grobbelaar A.O.
        • Hudson D.A.
        Flexor tendon injuries in children.
        J Hand Surg Br. 1994; 19: 696-698
        • Kwai Ben I.
        • Elliot D.
        “Venting” or partial lateral release of the a2 and a4 pulleys after repair of zone 2 flexor tendon injuries.
        J Hand Surg Br. 1998; 23: 649-654
        • Tang J.B.
        Indications, methods, postoperative motion and outcome evaluation of primary flexor tendon repairs in Zone 2.
        J Hand Surg Eur Vol. 2007; 32: 118-129
        • American Society for Surgery of the Hand
        The hand: Examination and diagnosis.
        Third ed. Churchill Livingstone, New York1990
        • Strickland J.W.
        • Glogovac S.V.
        Digital function following flexor tendon repair in Zone II: a comparison of immobilization and controlled passive motion techniques.
        J Hand Surg Am. 1980; 5: 537-543
        • Buck-Gramcko D.
        • Dietrich F.E.
        • Gogge S.
        [evaluation criteria in follow-up studies of flexor tendon therapy].
        Handchirurgie. 1976; 8: 65-69
        • Kane R.L.
        • Bershadsky B.
        • Rockwood T.
        • Saleh K.
        • Islam N.C.
        Visual analog scale pain reporting was standardized.
        J Clin Epidemiol. 2005; 58: 618-623
        • Bartoshuk L.M.
        • Duffy V.B.
        • Green B.G.
        • et al.
        Valid across-group comparisons with labeled scales: the gLMS versus magnitude matching.
        Physiol Behav. 2004; 82: 109-114
        • Strickland J.W.
        Management of acute flexor tendon injuries.
        Orthop Clin North Am. 1983; 14: 827-849

      Linked Article