The IFSSH consensus and current guidelines on flexor tendon repairs and reconstruction

Abstract

Background:

This article aims to summarize the current recommended methods, guidelines and consensus among a panel of international experts meeting at the 16th Congress of the International Federations for Societies for Surgery of the Hand in 2025 and discussion prior to or after the congress in the tendon study group.

Primary flexor tendon repair:

The updated guidelines and consensus emphasize (1) the use of strong and solid repair methods and true early active flexion in all flexor tendon repairs in zone 2, and also in zones 3–5, (2) no traditional running peripheral sutures when a six-strand repair is used, (3) not placing the knots between two tendon stumps, as the knots are foreign bodies and (4) abandoning place-and-hold exercise after surgery. Outcomes from the surgical units of these authors are reported to support these guidelines.

Secondary flexor tendon reconstruction:

This article also summarizes guidelines relating to secondary reconstruction of the flexor tendons. We collectively suggest one-stage tendon grafting for the patients without a lengthy destruction of the pulleys – that is – not needing pulley reconstruction. Staged tendon grafting should be reserved for patients who require pulley reconstruction in the first stage. Early active motion can be used after such one-stage tendon grafting procedures.

Conclusions:

Despite significant advances in flexor tendon repair and reconstruction, the drive towards perfection continues. The authors draw attention to outcomes obtained across the globe in recent years and highlight critical areas and pertinent technical points that the readers may use to improve their outcomes.