Efficacy of a new flossing intervention using a floss band for severe adhesion after digit tendon repair.

Background: Tendon adhesions after hand surgery can severely impair motion and function. Although early mobilization is preferred, re-ruptures or complex trauma cases often require immobilization, increasing the risk of adhesion. Purpose: This report presents two cases-one involving flexor pollicis longus (FPL) tendon re-rupture and another with multiple extensor tendon injuries-treated with a novel flossing intervention aimed at improving tendon gliding and soft tissue flexibility. Methods: In both cases, flossing therapy using a rubber compression band was introduced at 8 weeks postoperatively, following standard immobilization and rehabilitation protocols. Patients performed flossing exercises daily under supervised and home-based conditions. Results: The FPL case showed an improvement in %TAM from 20.8% to 83.3%, and the extensor tendon case improved from 42.9%-50% to 96.4%-98.4% over 16 weeks. Both patients regained functional range of motion and returned to work without requiring tenolysis. Importantly, these improvements occurred when flossing was paired with active range of motion (AROM) exercises, rather than by flossing alone. Conclusions: Flossing, particularly when combined with active range of motion (AROM) exercises, may be a useful adjunct to conventional therapy for managing severe adhesions after tendon repair. These case reports suggest that improvements were likely achieved through the combined effect of flossing and conventional active exercises, rather than flossing alone. Further studies are needed to determine the optimal parameters and generalizability of this technique.