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The Morbidity of the Button-over-Nail Technique for Zone 1 Flexor Tendon Repairs. Should we still be using this Technique?

From the Department of Plastic Surgery, Mount Vernon Hospital, Northwood, Middlesex, UK

Correspondence: Mr Norbert Kang, 6 Elgin Drive, Northwood, Middlesex, UK. Tel.: +44 1604 709 441. E-mail: mrkang{at}connectfree.co.uk.

The button-over-nail technique is commonly used to fix the core suture to the distal phalanx for flexor digitorum profundus repairs in zone 1. We report a retrospective study of 23 consecutive patients who had a repair of the flexor digitorum profundus tendon in zone 1 using the button-over-nail technique. Fifteen patients experienced a complication, of which ten were directly related to the button-over-nail technique. Complications included nail deformities, fixed flexion deformities of the distal interphalangeal joint, infections and prolonged hypersensitivity. Two patients required amputation of the fingertip. We recommend that the button-over-nail technique should be avoided or used only with caution and with close attention to the details of the technique.

Key Words: button-over-nail • pullout suture • zone 1 • flexor • injury • complications

Journal of Hand Surgery (European Volume), Vol. 33, No. 5, 566-570 (2008)
DOI: 10.1177/1753193408090118


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