Resection of one slip of FDS (may be through small transverse incisions)

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  1. Resection of one slip of FDS may significantly reduce friction as the tendons travel through zone 2 of the finger. This can be done through an open incision or a more limited mini transverse incision
  2. The important anatomical points to note are that the FDS bifurcates between A1 and A2 about 1cm to 1.5cm proximal to the palmar digital crease of the finger. Also Camper’s chiasm lies in the middle third of the zone B that lies between the palmar digital crease and the PIP skin crease. (see related science section of this web site  –  JHS publication)
  1. Note the FDP coming through the ducussation of the FDS as well as the 2 parts of Camper’s chiasm – a tendinous distal part and a strong synovial proximal part.  Both of these need to be divided
  2. Just proximal to the PIP skin crease find the distal extent of Camper’s chiasm. From this location close to the PIP joint skin crease divide the slip that is to be removed. Divide Camper’s chiasm from distal to proximal. Try to leave the vinculum major intact as this is done
  3. Make a small transverse incision in the distal palm approximately 1cm proximal to the palmar digital crease and deliver the divided slip of FDS
  4. Make a second incision at the proximal extent of A1 and deliver the slip of the FDS tendon which can then be removed
  5. Note the increased space within A1 and A2

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