Operative technique| Volume 44, ISSUE 8, P1662-1665, August 2009

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Flexor tendon repair in children with zone 2 injuries: an innovative technique using autogenous vein



      This is a new technique for tendon repair that may improve the results of existing methods.


      The study is a nonrandomized retrospective study using historical (nonconcurrent) controls. From May 1994 to March 2004, 53 children aged 5 to 15 years requiring tendon repair (test group) were compared to 53 children conventionally repaired (control group). All patients had flexor tendon injuries, involving zone 2. In the test group (53 patients), a modified Kessler repairing of tendons with 4-0 prolene was used, followed by a core suture of running 7-0 nylon or prolene epitendinous suture. After the tendon repair, a segment of vein through which the tendon had been passed before or a vein patch used as a tendon sheath substitute was used to repair the sheath defects. The results during 6 months of follow-up were compared with those of the control group that were operated using the conventional technique (modified Kessler method).


      We assessed the results by measuring the range of motion of the metacarpophalangeal, distal interphalangeal, and proximal interphalangeal joints in the follow-up period and graded them as excellent, good, fair, and poor. In the test group, 86% were graded as excellent, 11% good, 3% fair, and 0% poor results; and in the control group, 0% were excellent, 12% good, 38% fair, and 50% poor results. The differences were significant (P < .005).


      Our preliminary results appeared encouraging when compared with the outcomes achieved by the conventional tendon repair technique. As the new technique decreases the need for intensive physiotherapy, it may serve as a substitute method for the conventional tendon repair and eventually become a standard technique in the future.

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        • Hernandez-Jauregui P.
        • Esperanza G.
        • Gonzalez Angulo A.
        Morphology of the connective tissue grown in response to implanted silicone rubber: a light and electron microscopic study.
        Surgery. 1974; 75: 631-637
        • Colville J.
        Tendon graft function.
        Hand. 1973; 5: 152-154
        • Hunter J.M.
        • Schneider L.
        • Fietti V.G.
        Reconstruction of the sublimits finger.
        Orthop Trans. 1979; 3: 321-322
        • Mackin E.G.
        Physical therapy and the staged tendon graft: preoperative and postoperative management.
        in: AAOS Symposium on tendon surgery in the hand. CV Mosby, St. Louis. 1975: 283-291
        • Kahn S.
        Adynamic tenodesis of the distal interphalangeal joint for use after severance of the profondus alone.
        Plas Reconstr Surg. 1973; 51: 536-540
        • Inoue G.
        • Tamura Y.
        • Suzuki K.
        One stage repair of skin and tendon digital defects using the arterialized venous flap with palmaris longus tendon: an additional four cases.
        J Reconstr Microsurg. 1996; 12: 93-97
        • Conway H.
        • Smith J.W.
        • Elliot M.P.
        Studies on the revascularization of the tendons grafted by the silicone rod technique.
        Plast Reconstr Surg. 1970; 46: 582-587
        • Galanakis I.
        • Aligizakis A.
        • Katonis P.
        • et al.
        Functional evaluation after primary flexor tendon repair in zone II.
        Acta Orthop Belg. 2003; 69: 252-256
        • Herndon J.H.
        Treatment of tendon injuries in children.
        Orthop Clin North Am. 1976; 7: 717-731
        • Strickland J.W.
        • Glogovac S.V.
        Digital function following flexor tendon repair in zone II: a comparison of immobilization and controlled passive motion techniques.
        J Hand Surg [Am]. 1980; 5: 537-543