FTP1.9 Two-Stage flexor tendon repair versus Primary repair: An evaluation of subjective and functional outcomes at a Regional Centre for Plastic Surgery

Abstract

Abstract Aims The hand, as the primary executing organ, is at the centre of nearly all daily activities. In the anatomical extremity, the hand is frequently exposed to the potential risk of injury. If a flexor tendon is injured and recognized as needing surgical intervention, two main options are available; Two-stage Flexor Tendon (TSFT) repair or Primary repair. We evaluated the subjective and functional outcomes of the two surgical methods described above in patients presenting with flexor tendon injury in Zone I or II over a 5-year period. Methodology A retrospective study employing 35 patients (and a total of 42 tendon injuries) requiring TSFT repair over a 5-year period and 190 patients requiring primary flexor tendon repair between 2012-2014. Data collected included patient demographics, injury details, intraoperative findings and post-operative outcomes. Results Of the 35 digital injuries assessed, 15.8% had a good outcome, 21.1% with a fair outcome and 63.2% with a poor outcome, based upon the Strickland grading system. In comparison, of those undergoing primary flexor tendon repair, 51.5% had a good / Excellent outcome, leaving 48.5% with a poor outcome. Rupture rates post-surgery were higher in those undergoing TSFT repair than primary repair; 23.8% versus 12.0% respectively. Conclusion A damaged flexor tendon requiring surgery should ideally be repaired within 72 hours of initial insult via primary repair. Delayed presentation and subsequent scar formation with proximal stump retraction warrants a two-stage approach. It is widely accepted that a reconstruction in two-stages can yield effective results in restoring digital function, but these results are often superseded by a primary repair.