A prospective comparative study of pull-out suture technique versus modified Kessler technique in flexor tendon repair for Zone I and distal Zone II injuries

Abstract

Background: Injuries to the hand are common, and poor functional outcomes can have significant long-term consequences affecting both work and social activities. Good outcomes following flexor tendon lacerations in hand are dependent on a sound surgical repair allowing early active mobilization. Aims and Objectives: The purpose of the study was to compare the clinical and functional outcomes of Zone I and distal Zone II flexor tendon repair using pull-out suture technique with two-strand modified Kessler method. Materials and Methods: This hospital-based prospective study was conducted in a tertiary hospital setup in Manipur for 2 years' duration from November 2018 to November 2020. The study was conducted on 26 patients with a total of 30 injured digits, which were then divided into two equal groups of cases and control. Group A included study cases and were treated with pull-out suture technique. Group B included 15 control cases and were treated with modified Kessler technique. Comparison was done between the two different techniques based on patient variables and outcome measured with total active motion (TAM) evaluation system of the American Society for Surgery of Hands. Statistical Analysis: Data collected were entered into the SPSS version 16. Descriptive analysis of baseline characteristics of both study and control groups was done. The final analysis was done using the Chi-square test and SPSS version 16. P < 0.05 was taken as significant. Results: In our comparative study, at the 3-month follow-up range of motion was measured and TAM was calculated. Among case group, 2 (13%) belonged to good and 13 (87%) belonged to fair category, whereas among control group, 2 (13%) belonged to good and 1 poor category, and 12 (80%) belonged to fair category. About 50%–75% of functional recovery by 3 months was obtained in 80% of the cases and 73% of the control group. Conclusion: The pull-out suture technique is a good option for the management of Zone I and distal Zone II flexor tendon injuries.