Comparison of two Methods of Flexor Tendon Retrieval in Zone II: Hemi Kessler Core Suture Tendon Retrieval and the Use of Long Loop of Nylon Suture without Pulling out the Tendons from the Sheath

Introduction & The purpose of this study was to compare the effect of two methods of tendon retrieval in the outcome of the repair of retracted flexor tendons in zone II flexor tendon laceration. In a randomized controlled trial, the Hemi Kessler core suture tendon retrieval was compared with the innovative method of retrieval by long loop of nylon suture without Pulling out the tendons from their sheath. Between September 2009 and July 2010 a total of 253 patients (307 fingers) with flexor tendon injury in zone II referred to the hand surgery ward in 15 Khordad hospital for whom if tendon was retracted to the palm and could not be brought into view by massage at the time of operation, joint flexion and other simple methods were included in our study. A small transverse incision was made over distal palmar crease and both flexor tendons were visualized and flexor tendons were randomly retrieved by two methods. In 36 patients (38 fingers) of control group tendon retrieval was done by Hemi Kessler core suture method and in 34 patients (37 fingers) of study group tendon retrieval was done by the use of long loop of nylon and nelaton chateter, without Pulling out the tendons from the sheath. The TAM (Total Active Motion) of the repaired fingers in both groups were calculated and scoring was done according to ASSH system. In all of our patients the contralateral finger was normal and accessible for comparison. The average follow up time was 368 days (ranging from 274 to 450 days). The average TAM was 208.1o in study group and 201.5o in control group. There was no statistically significant difference in the end results of both groups which was evaluated according to TAM (ASSH) system (P = o.408). The outcome of two groups were compared, according to the ASSH scoring of excellent, good, fair and poor. The results in the study group were: 2 excellent (5.2 %), 27 good (73%), 7 fair (18.9%) and 1 poor (2.7%). Results in the control group were 3 excellent (7.9%), 24 good (63.2%), 10 fair (26.3%) and 1 poor (2.6%). There was no statistically significant different between the two groups) P = 0.827(. Despite the fact that there was no significant differences in the results, we suggest retrieving of proximal tendon stump of retracted severed flexor tendons in zone II, without bringing them out of the sheath, thereby avoiding excessive trauma to the tendon and preserving its blood supply and tendon sheath integrity.