Hunter procedure for tenosynovitis management. A case report

Background: Pyogenic flexor tenosynovitis (PFT) is a closed space infection that can lead to stiffness, functional loss and even amputation. In zone II lesions complicated with severe adhesions and disruption of the pulley system, two-stage reconstruction using the Hunter procedure represents an effective management option. Case report We present a 65-year-old male patient with a history of diabetes mellitus and smoking, who developed PFT secondary to a puncture wound in the third finger of the right hand, with evolution to functional sequelae after primary tenorrhaphy. Neotendinous sheath reconstruction was performed by Hunter's procedure, using a 20 Fr silicone feeding tube as a substitute for Hunter's rod due to lack of availability. During surgery, extensive fibrosis and absence of the pulley system were identified, so they were reconstructed using removed superficial flexor tissue. The patient presented favorable postoperative evolution, with preservation of sensibility, without complications, with progressive improvement of mobility, and is currently in protocol for the second phase of reconstruction. Discussion The Hunter procedure allows restoration of digital function in complex zone II lesions, being especially useful in cases with severe adhesions and pulley disruption, even in resource-limited settings using alternatives such as feeding tubes instead of the traditional silicone rod. A structured rehabilitation protocol is essential to maximize functional recovery. Conclusion Two-phase reconstruction with the Hunter technique is an effective strategy for the management of functional sequelae after PFT in zone II, allowing recovery of digital function in cases of severe structural damage, with options adaptable to resource-limited settings. Key words: Flexor tendon reconstruction, Hunter procedure, Pyogenic flexor tenosynovitis, Two-stage tendon reconstruction