Volume 12, Issue 2 (2023)                   WJPS 2023, 12(2): 34-40 | Back to browse issues page

XML Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Heydari M B, Porhesam Y, Rouzbahani A K, Mahmoudvand G, Mahmoudvand H. Comparison of Six-strand and Four-strand Techniques on the Repair of Injured Deep Flexor Tendons of Zone II of the Hand: A Randomized Controlled Clinical Trial. WJPS 2023; 12 (2) :34-40
URL: http://wjps.ir/article-1-1052-en.html
1- Department of Surgery, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
2- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
3- USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
4- Department of Surgery, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
Abstract:   (1322 Views)
Background: Hand zone II flexor tendon repair had been associated with many complications thereby it was previously called no man's land. Although there is some agreement on the primary repair of flexor tendons in this area, it is challenging due to certain complications. 
We compared the six and four-strand techniques in the repair of flexor digitorum profundus (FDP) tendons of zone II.
Methods: This randomized controlled clinical trial was registered with the Iranian Registry of Clinical Trials (IRCT20130812014333N139). Fifty patients with damaged FDP in zone II of the hand who were referred to Taleghani Hospital, Kermanshah, Iran in 2020 were included and divided into two groups (n=25). In group 1, the damaged tendons were repaired using the four-strand technique and prolene suture while in group 2, the six-strand technique was used. Postoperatively, the patients were examined every week for the first three weeks. In the second and third weeks, sutures were removed. At the end of 3rd month, the outcomes of surgery were compared in the groups.
 Results: Fifty patients (74% male) with 85 damaged fingers were investigated. Based on Buck-Gramcko criteria, the outcomes of surgery were excellent in 78%, good in 16%, fair in 4%, and bad in 2%. Complications after surgery were adhesion (8%) and 2 cases of rupture. There was no significant difference between 4 and 6-strand sutures regarding tendon adhesion and range of motion. 
Conclusion: Both 4 and 6-strand sutures were associated with favorable outcomes in patients with damaged FDP in zone II of the hand.
Full-Text [PDF 446 kb]   (982 Downloads)    
Type of Study: Original Article | Subject: Special
ePublished: 2023/09/23

1. Lee YJ, Ryoo HJ, Shim H-S. Prevention of postoperative adhesions after flexor tendon repair with acellular dermal matrix in Zones III, IV, and V of the hand: A randomized controlled (CONSORT-compliant) trial. Medicine 2022;101(3). [DOI:10.1097/MD.0000000000028630]
2. Klifto CS, Bookman J, Paksima N. Postsurgical rehabilitation of flexor tendon injuries. J Hand Surg Am 2019;44(8):680-6. [DOI:10.1016/j.jhsa.2019.02.010]
3. Venkatramani H, Varadharajan V, Bhardwaj P, Vallurupalli A, Sabapathy SR. Flexor tendon injuries. J Clin Orthop Trauma 2019;10(5):853-61. [DOI:10.1016/j.jcot.2019.08.005]
4. Bunnell S. Repair of tendons in the fingers and description of two new instruments. Surg Gynecol Obstet 1918;26:103-10.
5. Fulchignoni C, Bonetti MA, Rovere G, Ziranu A, Maccauro G, Pataia E. Wide awake surgery for flexor tendon primary repair: A literature review. Orthop Rev (Pavia) 2020 Jun 29;12(Suppl 1):8668. [DOI:10.4081/or.2020.8668]
6. Ishak A, Rajangam A, Khajuria A. The evidence-base for the management of flexor tendon injuries of the hand: Review. Ann Med Surg (Lond) 2019 Dec;48:1-6. [DOI:10.1016/j.amsu.2019.10.006]
7. Lutsky KF, Giang EL, Matzon JL. Flexor tendon injury, repair and rehabilitation. Orthop Clin North Am 2015;46(1):67-76. [DOI:10.1016/j.ocl.2014.09.004]
8. Gibson PD, Sobol GL, Ahmed IH. Zone II Flexor Tendon Repairs in the United States: Trends in Current Management. J Hand Surg Am 2017 2017/02/01/;42(2):e99-e108. [DOI:10.1016/j.jhsa.2016.11.022]
9. Hess GP, Cappiello WL, Poole RM, Hunter SC. Prevention and treatment of overuse tendon injuries. Sports Med 1989 Dec;8(6):371-84. [DOI:10.2165/00007256-198908060-00005]
10. Unsal SS, Yildirim T, Armangil M. Comparison of surgical trends in zone 2 flexor tendon repair between Turkish and international surgeons. Acta Orthop Traumatol Turc 2019 2019/11/01/;53(6):474-7. [DOI:10.1016/j.aott.2019.07.003]
11. Osada D, Fujita S, Tamai K, Yamaguchi T, Iwamoto A, Saotome K. Flexor tendon repair in zone II with 6-strand techniques and early active mobilization. J Hand Surg Am 2006 Jul-Aug;31(6):987-92. [DOI:10.1016/j.jhsa.2006.03.012]
12. Buck-Gramcko D, Dietrich F, Gogge S. Evaluation criteria in follow-up studies of flexor tendon therapy. Handchirurgie 1976;8(2):65-9.
13. Çetin A, Dinçer F, Keçik A, Cetin M. Rehabiliation of flexor tendon injuries by use of a combined regimen of modified Kleinert and modified Duran techniques. Am J Phys Med Rehabil 2001;80(10):721-8. [DOI:10.1097/00002060-200110000-00003]
14. Behdaneh R, Boozari-Poorboeini B, Ansari-Poor M. The investigation of the repair of acute trauma to flexor tendons of Zone II. Zahedan Journal of Research in Medical Sciences 2005;7(3).
15. Tang JB, Xu Y, Chen F. Impact of flexor digitorum superficialis on gliding function of the flexor digitorum profundus according to regions in zone II. J Hand Surg Am 2003 Sep;28(5):838-44. [DOI:10.1016/S0363-5023(03)00300-9]
16. Güntürk ÖB, Kayalar M, Kaplan İ, Uludağ A, Özaksar K, Keleşoğlu B. Results of 4-strand modified Kessler core suture and epitendinous interlocking suture followed by modified Kleinert protocol for flexor tendon repairs in Zone 2. Acta Orthop Traumatol Turc 2018 2018/09/01/;52(5):382-6. [DOI:10.1016/j.aott.2018.06.003]
17. Stefanich RJ, Putnam MD, Peimer CA, Sherwin FS. Flexor tendon lacerations in zone V. J Hand Surg Am 1992 Mar;17(2):284-91. [DOI:10.1016/0363-5023(92)90407-G]
18. Moriya K, Yoshizu T, Maki Y, Tsubokawa N, Narisawa H, Endo N. Clinical outcomes of early active mobilization following flexor tendon repair using the six-strand technique: short- and long-term evaluations. J Hand Surg Eur Vol 2014 2015/03/01;40(3):250-8. [DOI:10.1177/1753193414551682]
19. Pan ZJ, Qin J, Zhou X, Chen J. Robust thumb flexor tendon repairs with a six-strand M-Tang method, pulley venting, and early active motion. J Hand Surg Eur Vol 2017 2017/11/01;42(9):909-14. [DOI:10.1177/1753193417723238]
20. Quadlbauer S, Pezzei C, Jurkowitsch J, Reb P, Beer T, Leixnering M. Early Passive Movement in flexor tendon injuries of the hand. Arch Orthop Trauma Surg 2016;136(2):285-93. [DOI:10.1007/s00402-015-2362-z]
21. Svingen J, Rosengren J, Turesson C, Arner M. A smartphone application to facilitate adherence to home-based exercise after flexor tendon repair: A randomised controlled trial. Clin Rehabil 2021;35(2):266-75. [DOI:10.1177/0269215520962287]
22. Dy CJ, Hernandez-Soria A, Ma Y, Roberts TR, Daluiski A. Complications after flexor tendon repair: a systematic review and meta-analysis. J Hand Surg Am 2012 Mar;37(3):543-51.e1. [DOI:10.1016/j.jhsa.2011.11.006]
23. Vaysman M, Alben M, Todd M, Ruotolo C. Pharmacologic Enhancement of Rotator Cuff Repair: A Narrative Review. Orthop Rev (Pavia) 2022;14(3):37782. [DOI:10.52965/001c.37782]
24. Khor WS, Langer MF, Wong R, Zhou R, Peck F, Wong JK. Improving outcomes in tendon repair: a critical look at the evidence for flexor tendon repair and rehabilitation. Plast Reconstr Surg 2016;138(6):1045e-58e. [DOI:10.1097/PRS.0000000000002769]
25. Edsfeldt S, Eklund M, Wiig M. Prognostic factors for digital range of motion after intrasynovial flexor tendon injury and repair: long-term follow-up on 273 patients treated with active extension-passive flexion with rubber bands. J Hand Ther 2019;32(3):328-33. [DOI:10.1016/j.jht.2017.12.007]
26. Moriya K, Maki Y, Tsubokawa N. Effect of age on the outcome of reconstruction for flexor tendon rupture following distal radial fracture. J Hand Surg Eur Vol 2021;46(5):549-52. [DOI:10.1177/1753193420981836]
27. Rigo I, Røkkum M. Predictors of outcome after primary flexor tendon repair in zone 1, 2 and 3. J Hand Surg Eur Vol 2016;41(8):793-801. [DOI:10.1177/1753193416657758]
28. Thurman RT, Trumble TE, Hanel DP, Tencer AF, Kiser PK. Two-, four-, and six-strand zone II flexor tendon repairs: an in situ biomechanical comparison using a cadaver model. J Hand Surg Am 1998 Mar;23(2):261-5. [DOI:10.1016/S0363-5023(98)80124-X]
29. Gil JA, Skjong C, Katarincic JA, Got C. Flexor tendon repair with looped suture: 1 versus 2 knots. J Hand Surg Am 2016;41(3):422-6. [DOI:10.1016/j.jhsa.2015.12.011]
30. Torres Fuentes CE, Carvajal Flechas FS, Hernández JA, et al. Helical 6-strand cruciate tenorrhaphy: description of a new technique and biomechanical comparative analysis with 2 standard techniques. HAND 2022;17(1):98-105. [DOI:10.1177/1558944719897132]

Add your comments about this article : Your username or Email:

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | World Journal of Plastic Surgery

Designed & Developed by : Yektaweb