Flexor Tendon Repair of The Right Fifth Finger Using Modified Kessler Tenorrhaphy and Palmaris Longus Tendon Graft: Case Report

Chronic flexor tendon injuries of the hand represent a major technical challenge due to degenerative changes, tendon retraction, and fibrosis that prevent primary repair. We report the case of a 63-year-old female patient who suffered a laceration on the right fifth finger that was inadequately treated and, one year later, presented with complete loss of active flexion. Tendon reconstruction was performed using an autologous palmaris longus tendon graft and a modified Kessler tenorrhaphy, preserving the anatomical pulleys and initiating early rehabilitation under a modified Kleinert protocol. The postoperative course was favorable, with progressive recovery of motion and complete functional restoration at six months, without complications or donor-site deficits. This case demonstrates that even in long-standing injuries, reconstruction with an autologous palmaris longus graft and an appropriate suture technique can successfully restore grasping function and manual dexterity.