Primary Flexor Tendon Repair in “No Man’s Land”

Abstract

Fifty-eight patients with 67 fingers with flexor tendon injuries in Bunnell's "no man's land" treated with primary repair were re-examined 14-84 months after surgery. Thirty-five fingers had repair of both tendons, and in thirty-two fingers the superficialis tendon was excised and only the profundus tendon was repaired. Postoperatively thirty-one fingers were treated by Kleinert's rubber band traction, and in thirty-six fingers a dorsal plaster of Paris was applied. The functional end-result was evaluated according to the method of Buck-Gramcko. Seventy-four per cent of fingers with suture of both tendons and 47 per cent of fingers with suture of only the profundus tendon attained an excellent or good result. The fingers treated by Kleinert's rubber band traction achieved the most favourable functional result, but many inconstant factors had influence upon this evaluation. The number of re-operations were significantly higher after repair of only the profundus tendon.

Complications After Flexor Tendon Repair: A Systematic Review and Meta-Analysis

“…Four studies did not exclusively use the modified Kessler technique; instead the authors employed a modified Bunnell suture, 16 multiple looped sutures, 17 or a heterogeneous mix of the Kessler technique with other techniques. 18,19 Age, gender, zone of injury, use of an epitendinous suture, study quality, and date of publication were not predictive of adhesion formation after flexor tendon repair.…”

Comparison of modified Kessler and Yotsumoto-Dona suture: A biomechanical study on porcine tendons

“…Lister et al (1977) found more frequently excellent or good function after FDS repair (18/21, 86%) compared to FDS resection (3/7, 43%) in conjunction with Kleinert's rehabilitation after primary FDP repair. Similarly, Nielsen and Jensen (1984) found significantly more excellent or good function after FDS repair (26/35, 74%) than after resection (13/32, 41%). In a recent cohort study of patients with EAM (Moriya et al, 2015) significantly better AROM was found in 50 fingers with concomitant FDS repair (mean 231, range 169-286 degrees) compared to 12 fingers with FDS excision (205, 143-275 degrees).…”

“…There is no consensus in the literature about treatment of concomitantly injured FDS tendons. Three comparative studies have shown significantly better outcomes with simultaneous repair of both the FDP and FDS tendons (Lister et al, 1977, Nielsen and Jensen, 1984, Moriya et al, 2015, whereas others have not (Brunelli et al, 1983, Ikuta and Tsuge, 1985, Tang, 1994. Earlier the concomitantly cut FDS tendons were routinely resected in our department, but recently we have recommended repair.…”

Gliding resistance after FDP and FDS tendon repair in zone II

“…Resection of the FDS may also affect nger motion, and cause a swan-neck deformity (Tubiana 1973). The other treatment option is to repair both of the damaged tendons (Lister et al 1977, Nielsen and Jensen 1984, Strickland 2000. There is evidence that suturing both tendons in this constricted canal may impair tendon gliding (Tang andShi 1992, Tang 1994).…”