Functional outcome of the delayed primary and early secondary repair of Zone V flexor tendon injury of the hand

Background and aims: The function of the hand and fingers is related to the normal integrity of the bones, tendons and neurovascular structures. Tendon injury often requires immediate repair. The present study was undertaken to assess the functional outcome of flexor tendon injury following delayed primary and early secondary repair of the hand’s Zone V flexor tendon injury. Methods: In this prospective clinical study, all patients having flexor tendon injury in zone V of hand that was operated in the Department of Plastic and Reconstructive Surgery, Gauhati Medical College and Hospital, Guwahati from January 2014 to August 2019 were included. All the cases were repaired by the modified Kessler method, and standard early postoperative physiotherapy using Kleinert protocol was used. Total active motion percentage (TAM) of individual fingers as per The American Society for Surgery of Hand (ASSH) protocol was calculated. Hand activities were assessed according to patient satisfaction. Results: A total of 155 patients with zone V flexor tendon injuries were evaluated. The age at injury ranged from 9 to 62 years. The most frequent mechanism of injury was accidental injury. Delayed primary repair was performed in 58.1% of patients and early secondary repairs in 41.9% of patients. The best TAM was found in the index finger (186.9) and worst in the ring finger (175.8). Ball compression activity had the best satisfactory outcome (83.9%). Conclusions: Tendon repair has a better outcome with delayed primary repair than early secondary repair, according to TAM. Postoperative early mobilization results in the satisfactory outcome of the hand activities.

Keywords: Flexor tendon injury, Delayed Primary Repair, Early Secondary Repair, Total active motion