Flexor tendon lacerations have historically not been repaired by emergency providers due to the extensive pulley systems involved and possibility of loss of mobility from scarring.
However, if both ends of the tendon can be visualized in the ED it is not unreasonable to place 1 or 2 horizontal mattress sutures between the two ends to prevent retraction of the proximal portion which can make a formal repair more difficult.
Extensor tendon lacerations can be repaired by emergency providers.
One technique is to use a running horizontal mattress suture with non-absorbable nylon sutures.
The ultimate strength of the repair is dependent on the number and size of the sutures placed.
Careful placement of the sutures can prevent gap formation between the ends when the tendon is stressed.
A reasonable approach to all tendon lacerations is to close the wound and splint in the hand in the position of function until the patient can be seen by a hand surgeon in the next 1-3 days. These injuries do not require immediate surgical repair.
