A 38-year-old man presented to the emergency department with a chief complaint of traumatic amputation of index fingertip of left hand and deep laceration to middle finger during an accident at work with a wood cutting machine. On examination severe injury to the flexor digitorum profundus tendon of middle finger occurred + injury to digital nerve and artery on the ulna side of the finger. Replantation of amputated fingertip was not practical because of the quality of the artery due to the grinder blade and also because it was too distal.

The patient was transferred to the operating room for emergency exploration and repair of the digital artery, nerve and flexor tendon.

During operation the wound was washed copiously with saline h202 and iodine solution and debridement was done + index finger was resected up to the Distal interphalangeal joint.

The middle finger flexor tendon was repaired using 3-0 prolene using the Kessler technique. Under microscope guidance the middle finger artery was sutured using 10-0 prolene and the nerve was sutured with 10-0 prolene epiperineraux suture. The A3 and A2 pulley was also repaired using 6-0 prolene.

The wound was washed again and the skin closed with prolene 3-0.

A Duran backslab was applied to protect the flexor tendon repair. It allows passive flexion of the finger and prevent over extension to prevent rupture of the tendon. Post operatively the patients continued to receive antibiotics and pain killers.