Clinical Characteristics Associated with the Prognosis of One-Stage Grafting for Flexor Digitorum Profundus Reconstruction in Zones I and II

Relative efficacy of three different tendon repairs in complete flexor digitorum profundus laceration in Zone I: A randomized controlled study

Hand flexor tendon injuries are common and biomechanically challenging to achieve good functional outcomes. Several approaches using the Pennington-modified Kessler repair technique have been attempted, but high-level evidence is still lacking. Here, we evaluated the relative efficacy of three versions of the Pennington-modified Kessler technique in repairing complete flexor digitorum profundus (FDP) laceration in Zone 1. We conducted a 2-year, single-center, double-blind, randomized clinical trial involving 85 patients with 105 digits enrolled between June 1, 2017 and January 1, 2019. Eligible participants were 20-60 years of age and underwent tendon repair in the acute phase for complete FDP laceration distal to the insertion of the superficial flexor tendon. The digits were randomized 1:1:1 to three treatment groups: (1) Pennington-modified Kessler repair; (2) Pennington-modified Kessler repair followed by circumferential tendon suture; or (3) Pennington-modified Kessler repair followed by circumferential epitenon suture. The primary endpoint was total active range of motion (TAROM) at 2 years after the initial surgery. The secondary endpoint was the reoperation rate. Compared with group 1, both techniques for peripheral suture were associated with a decrease in TAROM at 2 years after surgery. The total reoperation rates of the three groups were 11.4%, 18.2%, and 17.6%, and we found no significant differences among the three groups possibly due to the limited sample size. Unexpectedly, among participants with complete FDP laceration in Zone I, both circumferential-tendon and circumferential-epitenon sutures caused worsening of TAROM after 2 years. No conclusions can be drawn regarding reoperation rates among the groups. Level of evidence: Therapeutic level I.

Comparing the outcomes of fingertip-to-palm and fingertip-to-forearm two-stage flexor tendon reconstruction for isolated flexor digitorum profundus tendon injuries

Flexor tendon injuries of the hand have devastating consequences when primary tendon repair fails or left untreated in the first place. Flexor tendon reconstruction is a substantial treatment option to obtain functional digit. In this study, we aimed to compare the functional outcomes and technical feasibility of fingertip-to-palm and fingertip-to-forearm tendon reconstruction methods. Thirty-five patients were divided into two groups according to the proximal attachment site of the free tendon grafts. Group I consisted of 18 patients whose tendon grafts were placed from fingertip-to-palm (zone III). Group II consisted of 17 patients whose tendon grafts were placed from fingertip-to-forearm (zone V). The mean of 39.6 months (range, 6-52 months) of follow-up with complete clinical data were obtained for all the cases. The mean length of the tendon grafts used in group I and group II was 9.7 ± 1.4 cm and 15.9 ± 1.2 cm, respectively. Significantly shorter tendon grafts were needed in group I (p < 0.001). Both mean DASH score and mean Michigan score were significantly improved postoperatively in both groups (p = 0.0001, p = 0.0001), but there was no significant difference between two groups based on postoperative DASH score (p = 0.112) and Michigan score (p = 0.151). No statistically significant difference was observed between two groups in terms of Strickland's scores (p = 0.868). This study demonstrates that comparable results can be obtained with fingertip-to-palm and fingertip-to-forearm staged tendon reconstructions. Fingertip-to-palm tendon reconstruction seems to be more advantageous when multiple flexor tendon injuries aimed to be reconstructed, in which requirement of tendon graft can be fulfilled with less donor site morbidity.Abbreviations: DASH: disabilities of the arm, shoulder and hand.