Reoperation Following Zone II Flexor Tendon Repair

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Trauma Surgery

Background:

• Zone II flexor tendon repair aims for strength to prevent rerupture and adhesion.
• Reoperation is a significant concern following primary zone II flexor tendon repair.
• Identifying factors associated with reoperation is crucial for improving patient outcomes.

Purpose of the Study:

• To determine factors associated with reoperation after primary zone II flexor tendon repair.
• To evaluate the impact of different surgical techniques on reoperation rates.
• To provide clinical evidence supporting biomechanical findings on flexor tendon repair methods.

Main Methods:

• Retrospective case series of 252 fingers in 201 patients undergoing zone II flexor tendon repair.
• Data collected via medical record review, including demographics, injury, treatment, and complications.
• Reoperation defined as any unplanned surgical procedure post-initial repair.

Main Results:

• 19% of patients (49 fingers) required reoperation at a median of 5.5 months.
• Independent factors associated with reoperation included older age, workers' compensation claims, and Kessler-type flexor digitorum profundus repair.
• Kessler-type repairs showed a higher incidence of postoperative complications necessitating secondary surgeries.

Conclusions:

• Kessler-type flexor tendon repairs are associated with a higher risk of reoperation compared to non-Kessler techniques.
• Clinical findings correlate with in vitro biomechanical studies suggesting Kessler repairs are biomechanically inferior.
• Avoiding Kessler-type repairs may reduce postoperative complications and the need for reoperation in zone II flexor tendon injuries.