THE DIRECT MIDLATERAL APPROACH WITH LATERAL ENLARGEMENT OF THE PULLEYSYSTEM FOR REPAIR OF FLEXOR TENDONS IN FINGERS

The direct midlateral approach and the lateral enlarging procedure of the pulley system have been utilized in our service since 1972. The in cision runs directly behind the neurovascular pedicle, which is left i n the palmar skin flap of the anterior compartment of the finger, in o rder to ensure its blood supply and sensibility. The transverse digita l lamina of Landsmeer's skin anchoring system and Cleland's ligament a re preserved and are used to perform a lateral enlargement of the pull eys after tendon repair. The technique allows wide surgical exposure o f the digital fibro-osseous tunnel, enlargement and reconstruction of the pulley system and tendon sheath, flexor tendon repair (using the t echnique of choice) and reduces postoperative impingement in zone 2.