Abstract
Objectives:
This study introduces a modified M-Tang six-strand flexor tendon repair technique using a single loop suture with all knots within the repair line. The aim is to simplify the procedure, reduce costs, especially multiple tendon repairs, minimize surface swelling, preserve tendon vascularity, and provide eduquate mechanical strength for early active mobilization.
Technique:
The technique is a modification of the original M-Tang tendon repair method and uses 4-0 looped polydioxanone suture. The first locking knot is placed 1 cm proximal to the repair line using the Tsuge loop suture technique and is advanced intratendinously, exiting 1 cm distal to the repair line. An equal attachment distance of 1.0 cm is maintained on both sides of the repair line. The suture is then passed to the opposite side transversely, perpendicular to the long axis of the tendon. The Tsuge technique is repeated in reverse. The suture is removed intratendinously from the opposite side of the initial entry point and is locked by passing it through itself with appropriate tension. The suture is then passed transversely to emerge from the midline of the tendon. The suture is advanced within the tendon to exit the repair line. Then, one end of the looped suture is cut close to the needle. The needle, which has fallen into a single suture, is advanced through the tendon, exiting 1 cm distal, and then brought back through the tendon to the repair line. The suture is then tied with appropriate tension. When the procedure is completed, a triangular configuration is achieved on the sagittal axis with the apex facing the volar side, ensuring that the knot remains within the repair line. Peripheral sutures are intentionally omitted to reduce surface volüme and optimize tendon gliding.
Discussion:
Compared with classical six-strand techniques, the propesed method requires only a single knot, reduces the number of fixation points on the surface, and minimizes deformation by maintaining symmetry in the suture transition. The triangular placement preserves dorsal vascularity and reduces interference with tendon sliding. Although no biomechanical testing has been performed, it is anticipated that it will provide tensile strenght comparable to other six-strand techniques, with the added advantages of simplicity of procedure and reduced cost.
The modified M-Tang technique using a single loop suture offers a low profile, cost effective, and mechanically sound alternative for flexor tendon repair. Its configurations facilitates early active mobilization and may be particularly advantageous in situations where multiple tendon repairs are required.

Key words: flexor tendon repair; six-strand suture; looped suture; M-Tang technique