DELAYED PRIMARY REPAIR OF FLEXOR TENDON INJURY IN DISTAL FOREARM
Keywords:
Tendon, repair, Modified KesslerAbstract
Objective: To analyze the results of delayed primary tendon repair using modified Kessler technique in patients with
flexor tendon injury in distal forearm (hand zone V).
Material and Methods: The study was conducted at Liaquat University Hospital and a private practice setup at
Jamshoro from January 2010 to December 2011. A total of 50 adult patients were included in the study. The inclusion
criteria were adult patients having injury with sharp objects in zone five of hand, presenting between 24 hours to 10
ten days after injury. The exclusion criteria were associated vascular injury requiring repair, nerve injury, diabetes
mellitus, infection, and segmental loss in tendons. The primary outcome measures were, painless movement of
tendon, full range of movement of finger or wrist joint associated with the repaired tendon. Secondary outcome
measures were infection, limitation or painful movement of tendons, adhesions, dehiscence of repair leading to
tendon rupture at the repair site. Surgery was performed under general anesthesia and tourniquet. The tendons were
repaired with 3/0 proline, using modified Kessler technique.
Results: Out of 50 patients, 38 (76%) were male and 12 (24%) were female. The age range was between 20 to 65
years. Mean age was 34.40 years + 12.49 SD. The injury was caused by knife in 18(36%), glass in 16(32%), hatchet in
13(26%) and machine in 3 (6%) patients. Total number of tendon repaired was 115. (2.3 per patient). Tendon repair
was performed within 24 hours of admission in all patients. Modified Kessler technique was performed in all tendons
repairs. Thirty eight out of 50(76%) patients recovered fully and regained full range of pain free movement at wrist and
fingers in 8 to 12 weeks time. Mean time of recovery was 8.8 days + 1.319 SD. Six patients (12%) developed early post
operative superficial infection. These patients responded well to treatment and recovered normally in 8 to 12 weeks
time. Four (8%) patients develop adhesions resulting in limitation of movement at fingers, and two (4%) patients
develop rupture of tendon at the suture site, requiring second surgery.
Conclusion: Modified Kesslers suture technique of tendon repair is effective for delayed primary repair of flexor
tendon injury in distal forearm (zone V).
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