Flexor tendon pulley V-Y plasty: an alternative to pulley venting or resection

Zone 2 flexor tendon repairs can require "venting" or partial resection of the A2 and/or A4 pulleys. We propose and biomechanically assess a technique used by the authors in which the A2 and A4 pulleys are divided and repaired using a V-Y plasty. Two groups of cadaveric fingers were used, one group for assessing the A2 pulley and the second for assessing the A4 pulley. Prepared fingers were mounted onto custom-made jigs, tested using a servohydraulic testing machine and assessed for load to failure. The loads obtained were 75 N (SD = 26 N) and 234 N (SD = 73 N) for the A4 and A2 pulleys, respectively. These loads are well in excess of those one would anticipate during a postoperative active mobilization protocol. Tendon pulley V-Y plasty creates a mechanically sound pulley and maintains sufficient cover of the underlying tendon. This technique provides access to perform a tendon repair and/or permits free tendon gliding post-repair, thus providing an attractive alternative to simply "venting", or resecting, an otherwise troublesome pulley.