Gadallah, A., Etman, A., Abelhalim, M. (2023). Flexor Digitorum Superficialis Tendon Injuries in Zone II: To Repair or Not. The Egyptian Journal of Plastic and Reconstructive Surgery, 47(4), 319-325. doi: 10.21608/ejprs.2023.319998
Ahmed Gadallah; Adnan Gamal Etman; Mohamed M Abelhalim. "Flexor Digitorum Superficialis Tendon Injuries in Zone II: To Repair or Not". The Egyptian Journal of Plastic and Reconstructive Surgery, 47, 4, 2023, 319-325. doi: 10.21608/ejprs.2023.319998
Gadallah, A., Etman, A., Abelhalim, M. (2023). 'Flexor Digitorum Superficialis Tendon Injuries in Zone II: To Repair or Not', The Egyptian Journal of Plastic and Reconstructive Surgery, 47(4), pp. 319-325. doi: 10.21608/ejprs.2023.319998
Gadallah, A., Etman, A., Abelhalim, M. Flexor Digitorum Superficialis Tendon Injuries in Zone II: To Repair or Not. The Egyptian Journal of Plastic and Reconstructive Surgery, 2023; 47(4): 319-325. doi: 10.21608/ejprs.2023.319998
Flexor Digitorum Superficialis Tendon Injuries in Zone II: To Repair or Not
The Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University
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.
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