Skip to main content
Top
Published in:

01-12-2024 | Book Review

Flexor digitorum profundus tendon injuries with or without flexor digitorum superficialis tendon repair: a randomized controlled trail

Authors: Shaimaa Mostafa Gad, Ahmed Mohamed Sobhi, Ahmed Samy Saad, Mohamed Ibrahim Ebaid

Published in: European Journal of Plastic Surgery | Issue 1/2024

Login to get access

Abstract

Background

Flexor Zone 2, also called ‘the critical zone’ or ‘no man’s land’, presents challenges due to injuries that can result in damage to both the flexor digitorum profundus (FDP) and the flexor digitorum superficialis (FDS) tendons. The complexity of repairing tendons in this zone, along with the potential development of adhesions, can result in significantly impaired hand function. We aimed to evaluate the results, outcome, and necessity of repairing only the FDP tendon, versus repairing both the FDP and the FDS tendons, in a Zone 2 injury.

Methods

Ninety patients with acute flexor zone two injuries, who were being treated at the Plastic and Reconstructive Surgery Department at Cairo University, were included in the study. Patients were divided into three groups; Group (A) underwent isolated repair of the FDP tendon, Group (B) who underwent repair of the FDP tendon with a single slip of the FDS, and Group (C) who underwent repair of the FDP tendon with the two slips of the FDS tendon. Patients were randomly chosen by cyclic sequential allocation.

Results

There was no significant difference between groups regarding TAM, TPM, Tang grading system or ASSH TAF Score system (p = 0.728, 0.654, 0.225 and 0.872 respectively). Moreover, DASH Score and DASH Score work related did not show significant difference between groups (p = 0.731 and 0.413, respectively).

Conclusions

The findings imply that the repair of the FDS is not mandatory in Zone 2 injuries. The decision to repair the FDS tendon during surgery depends on the smoothness of the tendon gliding and is made intraoperatively. 
Level of Evidence: Level III, therapeutic study.
Literature
1.
go back to reference Çalışkan Uçkun A, Yurdakul FG, Ergani HM, Güler T, Yaşar B, Başkan B et al (2020) Factors predicting reoperation after hand flexor tendon repair. Ulus Travma Acil Cerrahi Derg 26:115–122 Çalışkan Uçkun A, Yurdakul FG, Ergani HM, Güler T, Yaşar B, Başkan B et al (2020) Factors predicting reoperation after hand flexor tendon repair. Ulus Travma Acil Cerrahi Derg 26:115–122
2.
go back to reference Tang JB, Wu YF, Cao Y, Chen CH, Zhou YL, Avanessian B et al (2016) Basic FGF or VEGF gene therapy corrects insufficiency in the intrinsic healing capacity of tendons. Sci Rep 6:20643CrossRef Tang JB, Wu YF, Cao Y, Chen CH, Zhou YL, Avanessian B et al (2016) Basic FGF or VEGF gene therapy corrects insufficiency in the intrinsic healing capacity of tendons. Sci Rep 6:20643CrossRef
3.
go back to reference Linderman SW, Gelberman RH, Thomopoulos S, Shen H (2016) Cell Biologic-Based Treat Flexor Tendon Injuries OperTechOrthop 26:206–215 Linderman SW, Gelberman RH, Thomopoulos S, Shen H (2016) Cell Biologic-Based Treat Flexor Tendon Injuries OperTechOrthop 26:206–215
4.
go back to reference Legrand A, Kaufman Y, Long C, Fox PM (2017) Molecular biology of flexor tendon healing in relation to reduction of tendon adhesions. J H Surg Am 42:722–726CrossRef Legrand A, Kaufman Y, Long C, Fox PM (2017) Molecular biology of flexor tendon healing in relation to reduction of tendon adhesions. J H Surg Am 42:722–726CrossRef
6.
go back to reference Mesplié G, Grelet V (2015) Injuries of the flexor tendons. In: MESPLIÉ G (ed) Hand and wrist rehabilitation: theoretical aspects and practical consequences. Springer International Publishing, ChamCrossRef Mesplié G, Grelet V (2015) Injuries of the flexor tendons. In: MESPLIÉ G (ed) Hand and wrist rehabilitation: theoretical aspects and practical consequences. Springer International Publishing, ChamCrossRef
7.
go back to reference Fulchignoni C, Bonetti MA, Rovere G, Ziranu A, Maccauro G, Pataia E (2020) Wide awake surgery for flexor tendon primary repair: a literature review. Orthop Rev (Pavia) 12:8668PubMed Fulchignoni C, Bonetti MA, Rovere G, Ziranu A, Maccauro G, Pataia E (2020) Wide awake surgery for flexor tendon primary repair: a literature review. Orthop Rev (Pavia) 12:8668PubMed
8.
go back to reference Saldana MJ (2010) Flexor tendon injuries. J Hand Surg Am 35(5):84652 Saldana MJ (2010) Flexor tendon injuries. J Hand Surg Am 35(5):84652
9.
go back to reference Kiefhaber TR, Stern PJ (1998) Acute flexor tendon repair. J Am Acad Orthop Surg 6(6):325–331 Kiefhaber TR, Stern PJ (1998) Acute flexor tendon repair. J Am Acad Orthop Surg 6(6):325–331
12.
go back to reference Bellemere P, Ardouin L (2014) [Primary flexor tendons repair in Zone 2]. Chir Main 33Suppl:S28−43 Bellemere P, Ardouin L (2014) [Primary flexor tendons repair in Zone 2]. Chir Main 33Suppl:S28−43
13.
go back to reference Dy CJ, Daluiski A (2014) Update on Zone II flexor tendon injuries. J Am Acad Orthop Surg 22:791–799CrossRefPubMed Dy CJ, Daluiski A (2014) Update on Zone II flexor tendon injuries. J Am Acad Orthop Surg 22:791–799CrossRefPubMed
14.
go back to reference Giesen T, Reissner L, Besmens I, Politikou O, Calcagni M (2018) Flexor tendon repair in the hand with the M-Tang technique (without peripheral sutures), pulley division, and early active motion. JH Surg Eur 43:474–479 Giesen T, Reissner L, Besmens I, Politikou O, Calcagni M (2018) Flexor tendon repair in the hand with the M-Tang technique (without peripheral sutures), pulley division, and early active motion. JH Surg Eur 43:474–479
15.
go back to reference Hwang MD, Pettrone S, Trumble TE (2009) Work of flexion related to different suture materials after flexor digitorum profundus and flexor digitorum superficialis tendon repair in Zone II: a biomechanicalstudy. J Hand Surg Am 34:700–704CrossRefPubMed Hwang MD, Pettrone S, Trumble TE (2009) Work of flexion related to different suture materials after flexor digitorum profundus and flexor digitorum superficialis tendon repair in Zone II: a biomechanicalstudy. J Hand Surg Am 34:700–704CrossRefPubMed
16.
go back to reference Paillard PJ, Amadio PC, Zhao C, Zobitz ME, An KN (2002) Pulley plasty versus resection of one slip of the flexor digitorum superficialis after repair of both flexor tendons in Zone II: a biomechanical study. J Bone Joint Surg Am 84:2039–2045CrossRefPubMed Paillard PJ, Amadio PC, Zhao C, Zobitz ME, An KN (2002) Pulley plasty versus resection of one slip of the flexor digitorum superficialis after repair of both flexor tendons in Zone II: a biomechanical study. J Bone Joint Surg Am 84:2039–2045CrossRefPubMed
17.
go back to reference Zhao C, Amadio PC, Zobitz ME, An KN (2002) Resection of the flexor digitorum superficialis reduces gliding resistance after zone II flexor digitorum profundus repair in vitro. J Hand Surg Am 27:316–321CrossRefPubMed Zhao C, Amadio PC, Zobitz ME, An KN (2002) Resection of the flexor digitorum superficialis reduces gliding resistance after zone II flexor digitorum profundus repair in vitro. J Hand Surg Am 27:316–321CrossRefPubMed
18.
go back to reference Natal-Albelo EJ, Olivella G, Paraliticci-Ma´rquez GU et al (2020) Functional and disability assessment among hispanics with Zone 2 flexor tendon injuries: comparative study between flexor digitorum superficialis repair and flexor digitorum superficialis excision. J Am Acad Orthop Surg Glob Res Rev 4:e2000081 Natal-Albelo EJ, Olivella G, Paraliticci-Ma´rquez GU et al (2020) Functional and disability assessment among hispanics with Zone 2 flexor tendon injuries: comparative study between flexor digitorum superficialis repair and flexor digitorum superficialis excision. J Am Acad Orthop Surg Glob Res Rev 4:e2000081
Metadata
Title
Flexor digitorum profundus tendon injuries with or without flexor digitorum superficialis tendon repair: a randomized controlled trail
Authors
Shaimaa Mostafa Gad
Ahmed Mohamed Sobhi
Ahmed Samy Saad
Mohamed Ibrahim Ebaid
Publication date
01-12-2024
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Plastic Surgery / Issue 1/2024
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-024-02249-3
SPONSORED

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

  • Webinar | 06-02-2024 | 20:00 (CET)

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Sponsored by:
  • Viatris
Developed by: Springer Healthcare
Watch now