In this article, I review how my team and I addressed clinical concerns in Zone 2 flexor tendon repair, and how major findings in each step of our research were translated into clinical practice. The focus of the article is on the thought processes behind each new investigation, the interpretation of research findings and conclusions drawn from the basic and clinical studies.
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2.
CaoYTangJB. Biomechanical evaluation of a four-strand modification of the Tang method of tendon repair. J Hand Surg Br. 2005a, 30: 374–8.
3.
CaoYTangJB. Investigation of resistance of digital subcutaneous edema to gliding of the flexor tendon: an in vitro study. J Hand Surg Am. 2005b, 30: 1248–54.
4.
CaoYTangJB. Resistance to motion of flexor tendons and digital edema: an in vivo study in a chicken model. J Hand Surg Am. 2006, 31: 1645–51.
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CaoYTangJB. Strength of tendon repair decreases in the presence of an intact A2 pulley: biomechanical study in a chicken model. J Hand Surg Am. 2009, 34: 1763–70.
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CaoYZhuBXieRGTangJB. Influence of core suture purchase length on strength of four-strand tendon repairs. J Hand Surg Am. 2006, 31: 107–12.
7.
DucournauFLiverneauxPA. Deliberate practice as a method of teaching surgery. J Hand Surg Eur. 2021, 46: 912–3.
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ElliotDGiesenT. Primary flexor tendon surgery: the search for a perfect result. Hand Clin. 2013, 29: 191–206.
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PanZJPanLXuYFMaTYaoLH. Outcomes of 200 digital flexor tendon repairs using updated protocols and 30 repairs using an old protocol: experience over 7 years. J Hand Surg Eur. 2020, 45: 56–63.
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PanZJQinJZhouXChenJ. Robust thumb flexor tendon repairs with a six-strand M-Tang method, pulley venting, and early active motion. J Hand Surg Eur. 2017, 42: 909–14.
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PanZJXuYFPanLChenJ. Zone 2 flexor tendon repairs using a tensioned strong core suture, sparse peripheral stitches and early active motion: results in 60 fingers. J Hand Surg Eur. 2019, 44: 361–6.
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TangJB. The double sheath system and tendon gliding in Zone 2C. J Hand Surg Br. 1995, 20: 281–5.
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TangJB. Indications, methods, postoperative motion and outcome evaluation of primary flexor tendon repairs in Zone 2. J Hand Surg Eur. 2007, 32: 118–29.
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TangJB. Outcomes and evaluation of flexor tendon repair. Hand Clin. 2013, 29: 251–9.
TangJB. Rehabilitation after flexor tendon repair and others: a safe and efficient protocol. J Hand Surg Eur. 2021, 46: 813–7.
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TangJBAmadioPCBoyerMI, et al.Current practice of primary flexor tendon repair: a global view. Hand Clin. 2013, 29: 179–89.
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TangJBCaoYWuYFWangGH. Effect of A2 pulley release on repaired tendon gliding resistance and rupture in a chicken model. J Hand Surg Am. 2009, 34: 1080–7.
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TangJBCaoYXieRG. Effects of tension direction on strength of tendon repair. J Hand Surg Am. 2001a, 26: 1105–10.
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TangJBIshiiSUsuiM. Surgical management of the tendon sheath at different repair stages. Biomechanical and morphological evaluations of direct sheath closure, partial sheath excision, and interposing sheath grafting. Chin Med J. 1990, 103: 295–303.
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TangJBLalondeDHarhausLSadekAFMoriyaKPanZJ. Flexor tendon repair: recent changes and current methods. J Hand Surg Eur. 2022, 47: 31–9.
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TangJBShiD. Subdivision of flexor tendon ‘no man’s land’ and different treatment methods in each sub-zone. A preliminary report. Chin Med J. 1992, 105: 60–8.
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TangJBShiDShenSQXieRGXuYSunWB. Morphological and functional investigations of Zone IIC of flexor tendons and the methods of tendon repair. Chin J Surg. 1999, 37: 639 [in Chinese].
26.
TangJBWangYHGuYTChenF. Effect of pulley integrity on excursions and work of flexion in healing flexor tendons. J Hand Surg Am. 2001b, 26: 347–53.
27.
TangJBXieRG. Effect of A3 pulley and adjacent sheath integrity on tendon excursion and bowstringing. J Hand Surg Am. 2001c, 26: 855–61.
28.
TangJBXuYWangB. Repair strength of tendons of varying gliding curvature: a study in a curvilinear model. J Hand Surg Am. 2003, 28: 243–9.
29.
TangJBZhangYCaoYXieRG. Core suture purchase affects strength of tendon repairs. J Hand Surg Am. 2005, 30: 1262–6.
30.
TangJBZhouXPanZJQingJGongKTChenJ. Strong digital flexor tendon repair, extension-flexion test, and early active flexion: experience in 300 tendons. Hand Clin. 2017, 33: 455–63.
31.
WangBXieRGTangJB. Biomechanical analysis of a modification of Tang method of tendon repair. J Hand Surg Br. 2003, 28: 347–50.
32.
WuYFTangJB. Effects of tension across the tendon repair site on tendon gap and ultimate strength. J Hand Surg Am. 2012, 37: 906–12.
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WuYFTangJB. Tendon healing, edema, and resistance to flexor tendon gliding: clinical implications. Hand Clin. 2013, 29: 167–78.
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WuYFTangJB. Recent developments in flexor tendon repair techniques and factors influencing strength of the tendon repair. J Hand Surg Eur. 2014, 39: 6–19.
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WuYFZhouYLTangJB. Relative contribution of tissue oedema and the presence of an A2 pulley to resistance to flexor tendon movement: an in vitro and in vivo study. J Hand Surg Eur. 2012, 37: 310–5.
36.
XieRGXueHGGuJHTanJTangJB. Effects of locking area on strength of 2- and 4-strand locking tendon repairs. J Hand Surg Am. 2005, 30: 455–60.
37.
XieRGTangJB. Investigation of locking configurations for tendon repair. J Hand Surg Am. 2005, 30: 461–5.
38.
XuYTangJB. Effects of superficialis tendon repairs on lacerated profundus tendons within or proximal to the A2 pulley: an in vivo study in chickens. J Hand Surg Am. 2003, 28: 994–1001.
