Flexor Digitorum Superficialis Tendon Injuries in Zone II: To Repair or Not

Gadallah, Ahmed; Etman, Adnan Gamal; Abelhalim, Mohamed M

doi:10.21608/ejprs.2023.319998

Flexor Digitorum Superficialis Tendon Injuries in Zone II: To Repair or Not

Document Type : Original Article

Authors

The Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University

10.21608/ejprs.2023.319998

Abstract

Background: Attaining favorable functional results after
flexor tendon repair in zone II has always been a complex
task. This is primarily due to the cramped positioning of the
flexor digitorum profundus (FDP) and the two slips of the
flexor digitorum superficialis (FDS) within a narrow fibroosseous
tunnel. Such a confined space significantly increases
the risk of postoperative adhesions and consequent limitations
in postoperative range of motion and strength. The primary
objectives of tendon restoration revolve around enhancing
tendon healing and minimizing adhesion formation.
Objective: The objective of this study is to evaluate the
clinical outcomes after surgery by assessing postoperative
range of motion (ROM) and radiological findings using
Musculoskeletal Ultrasound (MSK US). Specifically, we aim
to compare the results between cases where both the flexor
digitorum profundus (FDP) and flexor digitorum superficialis
(FDS) tendons are repaired in Zone II flexor tendon injuries,
and cases where only the FDP tendon is repaired. Additionally,
we will examine the formation of granulation tissue as a
parameter in our evaluation.
Patients and Methods: This interventional clinical trial
involves a total of fifty individuals who have experienced
flexor tendon injuries in zone II. The patients were selected
from those who underwent surgery at El Dmerdash Hospital,
based on the inclusion and exclusion criteria outlined in our
study. A random sampling method was employed to divide
the patients into two groups. Group I consist of twenty-five
patients (the study group) who underwent repair of both the
flexor digitorum profundus (FDP) and flexor digitorum superficialis
(FDS) tendons. Group II comprises twenty-five
patients (the control group) who underwent repair of only the
FDP tendon.
Results: In our investigation, 50 cases with four strand
repairs of zone II flexor tendon injuries were considered. The
rehabilitation and follow-up procedures were the same for
both groups. According to Strickland criteria, the results were
measured in terms of total range of motion and revealed
significant differences between the two groups. Group with
repair of both FDP and FDS has a higher range of motion.
MSK US showed a higher rate of granulation tissue formation
in group I but was not statistically significant.
319
Conclusion: In the management of flexor tendon injuries
zone II, we recommend repairing both FDP tendon and FDS
tendon to keep the integrity of full motion of the digit.
Repairing both slips of FDS in addition to FDP tendon may
increase the granulation tissue formation which impairs gliding
but that can be avoided by routine post-operative physiotherapy
and avoid bulky intra-operative repair.

Keywords

Main Subjects

Hand and Upper Limb Surgery'

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