Background: Flexor tendon reconstruction poses a technical challenge to the hand surgeon. Twostage tendon reconstruction is indicated in the event of irreparable tendon injury which could be either an acute or delayed event. First stage tendon reconstruction involves resection of the injured tendon and placement of a silicone Hunter rod in its place. The second and final stage of tendon reconstruction involves the harvest of autologous tendon grafts, most commonly palmaris longus and plantaris tendons, and grafting through the pseudosheath formed around the Hunter’s silicone rod.1 This final reconstruction is often performed 2-6 months after the initial operation after regular physiotherapy to maximise passive range of movement.

Materials & Methods: We conducted a retrospective consecutive case series of patients who underwent two-stage flexor tendon reconstruction using the Hunter’s silicone rod at a single plastic surgery unit from 2002-2018. A total of 13 patients underwent two-stage flexor tendon reconstruction. All patients had Hunter’s silicone rod insertion, with utilization of bone anchors and Pulvertaft tendon weave at the second stage.

Results: We present our detailed surgical technique and evaluated treatment outcomes include mean total active motion, mean power grip, mean tip pinch grip, quality of repair was assessed against the Buck- Gramcko scale and postoperative complication rate including need for revision surgery.

Conclusions: This presentation reflects our approach to two-stage flexor tendon reconstruction with particular attention to the surgical approach, Zones of repair, tendon fixation methods, adjusting the repair tension and a strict post-operative physiotherapy regime.