Repair Of Flexor Tendon In Zone II Using Minimal Incisions

Study Overview
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Brief Summary
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Repair of the zone II flexor tendon of the hand using minimal incisions is successful with good results which will improve the outcome of the repair.

Detailed Description
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Flexor tendon laceration in the hand is a common injury with unique characteristics owing to the anatomy of flexor tendons contained within a flexor sheath, requiring good surgical technique as well as strict rehabilitation protocol for regaining function. The hand is divided into 5 zones (Verdan's). Zone II is described by Bunnel as No Man's Land historically back to the 14th century (an area outside London used for executions) because it was previously believed that primary repair should not be done in this zone. After understanding flexor tendon anatomy, biomechanics, and healing new techniques of surgery and anesthesia repair is possible with good results. Lacerated tendons in zone II can retract proximally to the PIP if the vinculum longus is intact or into the palm if it is disrupted. It will not retract to the level of the wrist because of the origin of the lumbrical insertion into the extensor mechanism. The laceration can be extended in a Brunner incision or a mid-lateral exposure but it is better skin incisions are minimal to minimize postoperative finger edema, potential adhesions, and injury of any delicate structures. There are a lot of techniques to retrieve the proximal tendon end as milking, using a hemostat or second incision proximal to the A1 pulley where the tendon is tied to a looped wire of silastic tube and pulled distally through the laceration in the tendon sheath. But little studies discuss the effect of minimal incision on functional outcomes post-operative.

Official Title
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Results Of Repair Of Flexor Tendon In Zone II Using Minimal Incisions, A Case Series Study

Conditions
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Flexor Tendon Rupture

Intervention / Treatment
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* Procedure: repair of flexor tendon in Zone II


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age: between 16-60 years. Flexor tendon injuries of zone II of any medial four digits in both genders. within two weeks. Sharp mechanism of injury. Single-level injury Minimal surgical incision. Exclusion Criteria: Age less than sixteen years old or more than sixty years old. Amputation requiring replantation. Vascular injury requiring revascularization Associated fractures close to the tendon injury. Combined flexor and extensor tendon injury. Multiple-level injury Tendon substance loss Insufficient skin and soft tissue coverage. Surgical incision for whole tendon exposure.

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Minimal incisions in repair of Zone II flexor tendon of the hand instead of whole exposure of the tendon
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Minimal incisions<br>Repair of Zone II using minimal incisions | Procedure: repair of flexor tendon in Zone II<br>* Repair of Zone II flexor tendon of the hand using minimal incisions instead of whole tendon exposure<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| range of motions | range of motions of fingers using Jamar finger goniometer | end point 6 months post-operative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| complications | as adhesion formation, which limits active range of motion. joint contracture, tendon rupture, triggering, and pulley failure with tendon bowstringin Infection or neuroma | end point 6 months post-operative | 
| Healing vs failure of repair | questionnaire: can flex finger or not (yes or no) | baseline | 
| DASH score using DASH questionnaire | Disabilites of the Arm , Shoulder , Hand score (0-100) | 6 months |