Results of 4-strand modified Kessler core suture and epitendinous interlocking suture followed by modified Kleinert protocol for flexor tendon repairs in Zone 2

Abstract

ObjectiveThere has been no consensus in literature for the ideal flexor tendon repair technique. The results of zone 2 flexor tendon lacerations repaired primarily by 4 strand Modified Kessler core suture and epitendinous interlocking suture technique followed by Modified Kleinert protocol were investigated.Methods128 fingers of 89 patients who had flexor tendon laceration in zone 2 built the working group. Functional outcomes were evaluated using the Strickland formula. A statistical analysis was made between Strickland scores and some parameters such as age, gender, follow-up time, co-existing injury existence, repair time, single or multiple finger injury, tendon rupture and the effect of FDS injury and repair.ResultsExcellent, good, fair, poor results were obtained from 71 (55.5%), 46 (35.9%), 8 (6.3%), 3 (2.3%) fingers, respectively. Time of the repair has a significant effect on the strickland scores. Surgery performed within the first 24 hours following the injury gave better results. 3 fingers (2.3%) had tendon ruptures. Existence of ruptures affected the results significantly. Co-existing injuries were found that they did not have any effect on the results. In the fingers in which both FDP and FDS tendons were lacerated, no significant relationship was found between only FDP repair, both FDP and FDS repair and single FDS slip repair. Additionally no significant relationships between follow-up time, gender, single or multiple finger injury and Strickland scores were observed. 13 fingers (10.1%) had PIP joint contracture above 20°.ConclusionThe low rupture rate (2.3%) and 91.4% ‘good’ and ‘excellent’ scoring rates in our series support the idea that modified Kessler 4-strand core suture and epitendinous interlocking suture repair combined with modified Kleinert protocol gives satisfactory results. Repair time is one of the most important factors affecting the functional results and surgery should not be delayed if there is an experienced surgeon available.Level of evidenceLevel IV, therapeutic study.

Strength, bulk and surgery time of ex situ versus in situ flexor tendon repair in a cadaveric model

“…In several studies, the small finger was omitted from analysis due to the small size (Marrero-Amadeo et al, 2011;Xu et al, 2013;Zhao et al, 2004). We find this problematic since small finger flexor tendons are commonly lacerated (Gunturk et al, 2018;Su et al, 2005).…”

Polymer-Based Constructs for Flexor Tendon Repair: A Review

“…Clinically, a lot of different suture techniques are used such as Lin locking, Kessler, Modified Kessler, Savage, Becker, Tajima, grasping, and epitendinous suture [ 36 , 60 ]. The following two are widely accepted: (i) the Modified Kessler suture utilizing 2 sutures [ 61 ] and (ii) the grasping suture [ 62 ] which uses knots located in the cross-section.…”

The evidence-base for the management of flexor tendon injuries of the hand: Review

“…The outcomes from each type of repair are not reported individually but overall in zone 2, 95% of fingers had excellent-good functionality (53% and 42% respectively, Strickland-Glogovac criteria) [33]. More recently a 4-strand modified Kessler core suture (4–0 PDS) with an epitendinous locking suture (6-0 Nylon) technique has been described which achieved rupture rates of only 2.3% and excellent-good Strickland scores in 91.4% of fingers [34].…”