Flexor tendon reconstruction poses both a technical challenge to the hand surgeon and a rehabilitative challenge to the patient and therapist. The modified Paneva-Holevich technique, using a pedicled intra-synovial graft, is a safe and reliable means of staged flexor tendon reconstruction, offering a number of theoretical advantages over classic free-tendon grafting techniques. Clinical outcomes are at the least comparable, if not superior, to those achieved following free-tendon techniques with most authors reporting a low requirement for third stage tenolysis.