Widening of Pulley by Interdigitating Cuts.

Abstract

While biomechanically important, pulleys present multiple challenges to a zone 2 flexor tendon repair and rehabilitation. Retrieval of tendon through an intact pulley is cumbersome. Following repair, venting is often needed to accommodate the bulk at repair site. On occasion, step lengthening, or even complete division of pulley and reconstruction with tendon graft are necessary. Finally, accessing the tendon under the pulley during tenolysis is difficult. The primary issue in all such cases is the lack of space under the pulley. We describe a technique of expanding the pulley by interdigitating cuts. This technique greatly increases the diameter of the pulley which could be demonstrated in cadaver model and noted in clinical setting. This technique is easy to perform and maintains the integrity of the pulley without complete division. It would allow easy tendon retrieval, provide space for the repair and gliding, and improve exposure during tenolysis.