Massachusetts General Hospital, Boston, USA.
Hand (N Y). 2023 Sep;18(6):960-969. doi: 10.1177/15589447211043220. Epub 2022 Feb 26.
The goal of zone II flexor tendon surgery is to perform a repair with sufficient strength to withstand the forces encountered during rehabilitation. Postoperative rerupture and adhesion formation may lead to reoperation. This study aimed to determine the factors associated with reoperation after primary zone II flexor tendon repair.
In this retrospective case series, a total of 252 fingers in 201 patients underwent zone II flexor tendon repair. A medical record review was performed to collect data regarding patient demographics, injury and treatment characteristics and postoperative complications including reoperation. Reoperation was defined as any unplanned surgical procedure performed after initial flexor tendon repair.
There were 49 fingers (19%) in 42 patients that underwent reoperation at a median of 5.5 (interquartile range: 2.8-7.9) months. Older age, workers' compensation, and a Kessler-type repair of the flexor digitorum profundus were independently associated with reoperation.
In vitro studies suggest that Kessler-type repairs are inferior compared with other suture configurations. Our study demonstrates a clinical correlation to these biomechanical studies. Our results suggest that Kessler-type repairs are inferior compared with non-Kessler-type repairs, due to postoperative complications requiring secondary surgeries.
II 区屈肌腱手术的目的是进行修复，使其具有足够的强度来承受康复过程中遇到的力。术后再断裂和粘连形成可能需要再次手术。本研究旨在确定与原发性 II 区屈肌腱修复后再次手术相关的因素。
在这项回顾性病例系列研究中，共有 201 名患者的 252 个手指接受了 II 区屈肌腱修复。对病历进行了回顾性分析，收集了患者人口统计学、损伤和治疗特征以及包括再次手术在内的术后并发症的数据。再次手术定义为初始屈肌腱修复后进行的任何非计划手术。
42 名患者的 49 个手指（19%）在中位数为 5.5（四分位距：2.8-7.9）个月时进行了再次手术。年龄较大、工人赔偿和 Kessler 型屈指深肌腱修复与再次手术独立相关。
体外研究表明，Kessler 型修复不如其他缝线结构。我们的研究与这些生物力学研究具有临床相关性。我们的结果表明，Kessler 型修复不如非 Kessler 型修复，因为术后并发症需要二次手术。
