Articles Vol. 65 No. CĐ 1 - Liên chi hội Phẫu thuật bàn tay 12/03/2024

34. EVALUATION OF SURGICAL OUTCOMES OF FLEXOR TENDON REPAIR IN ZONE II OF THE HAND AT THE HOSPITAL FOR TRAUMATOLOGY AND ORTHOPAEDICS

Le Gia Anh Thy1,2, Le Minh Khoa1,2, Dinh Ngoc Minh1,2, Nguyen Viet Tan1,2, Le Hoang Khoi Nguyen1,2
1 Hospital for Traumatology and Orthopaedics, Ho Chi Minh city
2 Bệnh viện Chấn thương Chỉnh hình, thành phố Hồ Chí Minh
Corresponding author: giuseminhkhoale@gmail.com
DOI: 10.52163/yhc.v65iCD1.995
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Keywords
Core suture technique, hand surgery, Zone 2 flexor tendon.
Abstract

Background: Injuries resulting in flexor tendon lacerations in the upper limb are common. The flexor tendons in the hand are anatomically divided into 5 zones, each requiring different surgical approaches for tendon repair. Zone 2 injuries, in particular, pose challenges in repair techniques due to higher rates of tendon adhesion complications. Achieving secure tendon repair in Zone 2 to facilitate early active mobilization and minimize adhesion complications presents a treatment challenge.

Objective: The aim is to evaluate and compare the outcomes of surgical repair for Zone 2 flexor tendon injuries in the hand, as well as the re-rupture complication rates, between the two-strand core suture technique (Group A) combined with early passive motion exercises and the four-strand core suture technique (Group B) combined with early active motion exercises.

Materials and Methods: A retrospective descriptive study was conducted on 58 patients (comprising 88 fingers) with Zone 2 flexor tendon injuries who underwent primary tendon repair at the Hospital for Traumatology and Orthopedics in Ho Chi Minh City from January 2021 to June 2023. Group A consisted of 28 patients (45 fingers) with two-strand core sutures, while Group B consisted of 30 patients (43 fingers) with four-strand core sutures. Treatment outcomes were assessed based on grip strength, total active range of motion (TAM) of the fingers, surgical duration, and re-rupture rates. Results: Group B (four-strand core suture) demonstrated superior restoration of finger motion compared to Group A (two-strand core suture) with a significant difference (P = 0.038). There was no significant difference in grip strength between the two groups (P = 0.16). The re-rupture rate was 2.3% in Group B compared to 11,1% in Group A.

Conclusion: Four-strand core suture repair for Zone 2 flexor tendon injuries in the hand facilitates early active mobilization, resulting in significantly improved joint motion recovery compared to the two-strand technique. Additionally, the re-rupture rate is lower with the four-strand technique.

References
[1]
Scott WW, William CP, Scott HK et al., Green’s Google Scholar
[2]
operative hand surgery e-book. Elsevier Health Google Scholar
[3]
Sciences, 2021. Google Scholar
[4]
KL Silfverskiöld, EJ May, AH Törnvall, Flexor Google Scholar
[5]
digitorum profundus tendon excursions during Google Scholar
[6]
controlled motion after flexor tendon repair in Google Scholar
[7]
zone II: a prospective clinical study. J Hand Surg Google Scholar
[8]
Am, 1992. 17(1): p. 122-131. Google Scholar
[9]
Alice W, Sascha TB, Brigitte V et al., Fourstrand Google Scholar
[10]
core suture improves flexor tendon repair Google Scholar
[11]
compared to two-strand technique in a rabbit Google Scholar
[12]
model, Biomed Res Int, 2016. Google Scholar
[13]
MD Shaieb, DI Singer, Tensile strengths of Google Scholar
[14]
various suture techniques. J Hand Surg Br, 1997, Google Scholar
[15]
(6): p. 764-767. Google Scholar
[16]
JW Strickland, Development of flexor tendon Google Scholar
[17]
surgery: twenty-five years of progress. J Hand Google Scholar
[18]
Surg Am, 2000, 25(2): p. 214-235. Google Scholar
[19]
Pang L, Tong DL, Early Active Mobilization Google Scholar
[20]
Rehabilitation Protocol After Flexor Tendon Google Scholar
[21]
Repair in Zone II of the Hand: A Systematic Google Scholar
[22]
Review. 2016, Hand 11(1_suppl): p. 145S-145S. Google Scholar
[23]
Phạm Thị Thanh Hiền, Nguyễn Vũ Hoàng, Google Scholar
[24]
Nguyễn Thanh Tùng, Đánh giá kết quả phẫu Google Scholar
[25]
thuật khâu nối kỳ đầu gân gấp vùng II trong điều Google Scholar
[26]
trị vết thương bàn tay tại Bệnh viện trung ương Google Scholar
[27]
Thái Nguyên; Tạp chí Y học Việt Nam, 2022, Google Scholar
[28]
(2). Google Scholar
[29]
Ahmed FS, Aasem MN, Ahmed NE et al., Google Scholar
[30]
Fourstrands versus six-strands core sutures technique Google Scholar
[31]
for surgical management of acute zone II flexor Google Scholar
[32]
tendon injury; J Minia Journal of Medical Google Scholar
[33]
Research; 2020, 31(3): p. 291-297. Google Scholar
[34]
Ahmed FS , Flexor digitorum profundus with Google Scholar
[35]
or without flexor digitorum superficialis tendon Google Scholar
[36]
repair in acute Zone 2B injuries; J Hand Surg Google Scholar
[37]
Eur, 2020, 45(10): p. 1034-1044. Google Scholar
[38]
Chunfeng Z, Peter CA, Mark EZ et al., Resection Google Scholar
[39]
of the flexor digitorum superficialis reduces Google Scholar
[40]
gliding resistance after zone II flexor digitorum Google Scholar
[41]
profundus repair in vitro. J Hand Surg Am, 2002, Google Scholar
[42]
(2): p. 316-321. Google Scholar
[43]
Phạm Đình Ngân Thanh, Đánh giá hiệu quả Google Scholar
[44]
gập thụ động sớm theo nguyên tắc Kleinert và Google Scholar
[45]
Dunran sau khâu nối gân gập các ngón tay dài; Google Scholar
[46]
Luận văn Tốt nghiệp Bác sĩ Nội trú Đại học Y Google Scholar
[47]
Dược thành phố Hồ Chí Minh, Tp Hồ Chí Minh, Google Scholar
[48]
Nguyễn Quốc Thắng, Đánh giá kết quả điều trị đứt Google Scholar
[49]
gân gấp ngón II, III, IV, V bàn tay bằng phương Google Scholar
[50]
pháp khâu strickland; Luận văn tốt nghiệp Bác Google Scholar
[51]
sĩ Chuyên khoa II, Đại học Y khoa Phạm Ngọc Google Scholar
[52]
Thạch thành phố Hồ Chí Minh, 2022. Google Scholar
[53]
Khương Thiện Nhơn, Đánh giá kết quả điều trị Google Scholar
[54]
đứt gân gấp vùng II các ngón tay dài bằng phương Google Scholar
[55]
pháp khâu 4 sợi trục; Luận văn tốt nghiệp Bác Google Scholar
[56]
sĩ Chuyên khoa II, Đại học Y khoa Phạm Ngọc Google Scholar
[57]
Thạch thành phố Hồ Chí Minh, 2014. Google Scholar
[58]
Maryam F, Fereydoun L, Ali A et al., A Google Scholar
[59]
prospective randomized controlled trial of Google Scholar
[60]
controlled passive mobilization vs. place and Google Scholar
[61]
active hold exercises after zone 2 flexor tendon279 Google Scholar
[62]
repair. Hand Surg, 2014, 19(01): p. 53-59. Google Scholar
[63]
G L Hoffmann, U Büchler, E Vögelin, Vögelin, Google Scholar
[64]
Clinical results of flexor tendon repair in zone Google Scholar
[65]
II using a six-strand double-loop technique Google Scholar
[66]
compared with a two-strand technique; J Hand Google Scholar
[67]
Surg Eur Vol. 2008 Aug;33(4):418-23. Google Scholar
[68]
J O Small, M D Brennen, J Colville, Early active Google Scholar
[69]
mobilisation following flexor tendon repair in Google Scholar
[70]
zone 2; J Hand Surg Br, 1989, 14(4): p. 383-391. Google Scholar
[71]
P T Ali Kitis, Nihal Buker, Inci Gokalan Kara, Google Scholar
[72]
Comparison of two methods of controlled Google Scholar
[73]
mobilisation of repaired flexor tendons in zone Google Scholar
[74]
, Scand J Plast Reconstr Surg Hand Surg, Google Scholar
[75]
; 43(3):160-5. Google Scholar
[76]
Sandow M, M.J.A.H.C. McMahon, Singlecross Google Scholar
[77]
grasp six-strand repair for acute flexor Google Scholar
[78]
tenorrhaphy: modified Savage technique. 1996, Google Scholar
[79]
(01): p. 41-64. Google Scholar
[80]
Linda K, Early active motion flexor tendon Google Scholar
[81]
protocol using one splint. J Hand Ther, 2003, Google Scholar
[82]
(3): p. 199-206. Google Scholar