Outcome of early active mobilization in flexor tendon repair in zone II in hand.

Abstract Early controlled motion programs after flexor tendon repair in zone II of hand are designed to minimize adhesion formation by promoting the excursion of repaired tendons. The flexor tendon surgery especially in zone II is complicated. It is simplest in the newly injured and unscarred digit and the results of correctly rehabilitated primary repair are likely to be the best attainable. We conducted a study including 18 patients with 52 digits involving 80 flexor tendons in zone II to observe and record the result of the primary or delayed primary repair with early active mobilization protocol. Thirteen (72.22%) patients were below 30 years of age. Sixteen cases (88.89%) were sustained injury by sharp instrument either accidentally or by assault. Ring and little finger were involved in 50% instances. The repair was done with the modified Kessler core suture technique with locking epitendinous sutures with a knot inside the repair site, using polypropylene 4-0 and 6-0 sutures. The final assessment was done at 6 months post repair using the Louisville system of Lister et al. 61.54% (n=32) digits were shown excellent result whereas good results were seen in 23% (n=12) digits. Fair was shown 7.69% (n=4) digits and 7.69% (n=4) digits were shown poor results. P value was <0.001 by Z test which is significant. Complications included tendon rupture in 3(5.77%) cases (one thumb, one ring and one little finger) and contracture in 4(7.69%) cases whereas superficial infection and flap necrosis was seen in one (1.92%) case each. The primary or delayed primary repair of cut flexor tendons in zone II using the modified Kessler core suture and epitendinous suture with early active mobilization protocol has been given good result, with minimal complications.