Sửa chữa gân nên được thực hiện theo đồ ép cho máu cầm lại kiểm soát và gây mê thích hợp. Các vết rách da hiện có nên được mở rộng một cách cân bằng truy cập, vascularity nắp, và giới hạn chiều dài vết thương. | 58 Stephens et al. Surgical Preparation Tendon repair should be performed under tourniquet control and an appropriate anesthetic. The existing skin lacerations should be extended in a manner that balances access flap vascularity and limitation of wound length. Avoidance of longitudinal incisions passing volar to the joint axis is important in minimizing subsequent flexion contracture. Most often a zigzag volar pattern incision is employed as described by Bruner 56 . The utmost care should be taken to identify and preserve the neurovascular bundles. The tendon sheath should be opened enough to allow delivery of both proximal and distal tendon stumps. Flexing the wrist and fingers and even milking the palm from a proximal to distal direction to deliver a retracted proximal tendon stump is a way to facilitate this. Fine artery forceps passed down the flexor sheath can also be used however avoid blindly grasping down the sheath. A thrombus visible within the sheath indicates that the tendon stump is not too far away as these are often found on the end of the stump. If such measures fail to produce the tendon stump an incision should be made within the palm or even at the wrist level if necessary to find it. Once found it can then be passed distally down the sheath with the help of a fine catheter such as an infant-feeding tube. Once both tendon stumps are within the surgical field they can be secured in position by passing a fine needle through each and adjacent soft tissues taking care to avoid the neurovascular bundles. If the tendon ends are jagged these can be cleaned by excising a minimal amount ensuring that the tendons are not shortened too much as this will result in a permanent finger flexion contracture. In the uncommon situation where the tendon is lacerated at a very oblique angle greater than 10 mm of the length of the tendon the repair could be performed using the Becker method 57 . This method was proposed as a means of repairing all tendon injuries via
