Within what time frame should an acute clean finger tendon laceration be surgically repaired?

Timing of Surgical Repair for Finger Tendon Lacerations

For acute clean finger tendon lacerations, surgical repair should ideally be performed within 24 hours of injury, but excellent functional outcomes can still be achieved with repairs performed up to 2-5 weeks after injury when proper surgical technique and early mobilization protocols are followed. 1, 2

Immediate Management (0-24 Hours)

• Initial evaluation should include standard radiographs to rule out associated fractures or bony avulsions before proceeding with tendon repair. 3
• Wounds should be cleansed with sterile normal saline (no need for iodine- or antibiotic-containing solutions) and superficial debris removed. 3
• For clean lacerations without signs of infection, primary repair can proceed immediately without increasing infection risk. 4
• Antibiotic prophylaxis should be initiated early following injury, using amoxicillin-clavulanate or cefazolin for clean wounds. 3

Optimal Timing Window

Early Repair (0-2 Weeks)

• This represents the traditional "ideal" window, though no definitive "golden period" has been established in the literature. 4
• Primary repair during this timeframe allows for straightforward surgical technique without significant tendon retraction or adhesion formation. 1
• For extensor tendon injuries with bony avulsion fragments >1/3 of the articular surface, palmar displacement of the distal phalanx, or interfragmentary gap >3mm, operative fixation should be performed urgently. 3

Delayed Primary Repair (2-5 Weeks)

• Repairs performed 2-5 weeks after injury can achieve good to excellent functional outcomes in 73-87% of cases when proper surgical methods are used. 1, 2
• A study of 31 fingers/thumbs repaired at an average of 15 days (range 4-37 days) showed 87% excellent and good results using proper 6-strand core suture techniques with early mobilization. 2
• For isolated flexor digitorum profundus (FDP) lacerations in Zone I, delayed repairs up to 96 weeks achieved 82% good to excellent total active motion, with average DIP flexion of 35°. 1
• Zone II injuries involving both FDP and FDS have less favorable outcomes (45% good to excellent) when repaired late, compared to isolated FDP repairs (73% good to excellent). 1

Critical Factors That Matter More Than Timing

The time elapsed between injury and surgery is not the most important risk factor for outcome—proper surgical technique, surgeon experience, and early mobilization protocols are more critical. 2

Surgical Technique Requirements

• Use 6-strand core suture (M-Tang method) or double Tsuge suture with peripheral suture for optimal strength. 2
• For partial tendon lacerations involving 25-95% of cross-sectional area, do NOT repair the tendon—use early active mobilization instead, unless beveling is present. 5
• Beveled partial lacerations >25% cross-sectional area should be repaired with simple sutures. 5

Postoperative Mobilization

• Early partial-range active flexion exercises should begin within 2-4 weeks postoperatively using protective devices that limit dorsiflexion. 3, 2
• This protocol is essential regardless of repair timing to prevent adhesions and optimize functional recovery. 2

Common Pitfalls to Avoid

• Do not confuse acute traumatic tendon laceration with chronic tendinosis—these are entirely different conditions requiring different management. 6
• Do not assume that delays beyond 24 hours preclude good outcomes—studies show repairs up to 5 weeks can be successful. 1, 2
• Do not repair partial tendon lacerations unless beveling is present or the laceration exceeds 25% with beveling—early mobilization alone is superior. 5
• Adhesions may occur in 13% of delayed repairs but can be managed successfully with tenolysis. 2
• One rupture occurred in early active motion (3% rate) but was successfully re-repaired with good final outcome. 2

Contraindications to Delayed Repair

• Grossly contaminated wounds should not undergo primary closure and may require staged management. 3
• Signs of established infection (pain disproportionate to injury near bone/joint suggesting periosteal penetration, purulence, systemic signs) require debridement before definitive repair. 3
• Hand wounds with complications such as septic arthritis, osteomyelitis, or abscess formation necessitate source control before tendon repair. 3