Digital pulley reconstruction employing the always present rim of the previous pulley.

Several methods have been proposed for pulley reconstruction. Cleveland! described the use of a fascia lata graft sutured to either side of the fibrous sheath. Bunnell used a free tendon graft encircling both the flexor and extensor tendons or one slip of the superficialis tendon sutured to the opposite side of the phalanx. 2 Weckesseil passed a tendon graft through a drill hole in the phalanx and encircled the flexor tendon. Wray and Weeks4 reported the use of silicone rubber and Dacron arterial grafts as synthetic substitutes for the fibrous pulley system. Because the methods described do not duplicate the size or number of the original pulleys and require prolonged immobilization of the graft before motion is permitted, a technique of pulley reconstruction as employed by Andreas Weilby5 of Denmark is described. It appears to be strong and allows immediate motion.